Provider Demographics
NPI:1003332438
Name:TANGUMA, ANGELA MARIA (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:TANGUMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 CROSSPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1803
Mailing Address - Country:US
Mailing Address - Phone:956-381-5817
Mailing Address - Fax:956-381-5397
Practice Address - Street 1:4150 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-381-5817
Practice Address - Fax:956-381-5397
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134870363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385897901Medicaid
TXH08JU15201OtherBCBS