Provider Demographics
NPI:1528309739
Name:PENA, ANGELA MICHELLE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:PENA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:BLD 7, STE. 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5215
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-334-2702
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:LL2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:512-334-2638
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP122809363L00000X
TX710258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324078001Medicaid
TX295579YN56Medicare PIN
TX295579YN57Medicare PIN