Provider Demographics
NPI:1831808104
Name:PENA, ALBA VICTORIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:VICTORIA
Last Name:PENA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:ALBA
Other - Middle Name:VICTORIA
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:6 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3729
Mailing Address - Country:US
Mailing Address - Phone:617-724-2000
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290770163WS0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0200XNursing Service ProvidersRegistered NurseSchool