Provider Demographics
NPI:1457795957
Name:VASQUEZ, ANA AMPARO PENAS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANA AMPARO
Middle Name:PENAS
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 TROON AVE SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9187
Mailing Address - Country:US
Mailing Address - Phone:360-876-2120
Mailing Address - Fax:
Practice Address - Street 1:2505 SOUTH 38TH ST
Practice Address - Street 2:BLDG A SUITE 109
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-274-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60084656364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health