Provider Demographics
NPI:1699039883
Name:PINA, ANNA LILIA (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LILIA
Last Name:PINA
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 W SOUTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-2041
Mailing Address - Country:US
Mailing Address - Phone:918-734-2362
Mailing Address - Fax:918-310-1058
Practice Address - Street 1:3562 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3518
Practice Address - Country:US
Practice Address - Phone:918-734-2362
Practice Address - Fax:918-310-1058
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
OK0088067363LF0000X
OKR0088067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880IMedicaid
OK200455350 AMedicaid
OK100768880 OMedicaid
OK100768880FMedicaid
OK100768880JMedicaid