Provider Demographics
NPI:1457985764
Name:BAEZA, ANAYA (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANAYA
Middle Name:
Last Name:BAEZA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-0832
Mailing Address - Country:US
Mailing Address - Phone:815-988-0267
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5456
Practice Address - Country:US
Practice Address - Phone:404-882-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003226363LP0808X
GAGAA-NP000632363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health