Provider Demographics
NPI:1952883571
Name:LABORDE, ANA LINDA (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LINDA
Last Name:LABORDE
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LINDA
Other - Last Name:VERGEL DE DIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-1278
Mailing Address - Country:US
Mailing Address - Phone:089-945-5752
Mailing Address - Fax:208-994-5576
Practice Address - Street 1:219 S WOODDALE AVE
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7714
Practice Address - Country:US
Practice Address - Phone:208-994-5575
Practice Address - Fax:208-994-5576
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730989363LA2200X, 363LG0600X
ID59811363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology