Provider Demographics
NPI:1992478507
Name:ANAYA, STEPHEN ANDREW (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:ANAYA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 DUSK CREEK PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3133
Mailing Address - Country:US
Mailing Address - Phone:915-502-9440
Mailing Address - Fax:
Practice Address - Street 1:1331 JAMES WATT RD
Practice Address - Street 2:BLDG. 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-206-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily