Provider Demographics
NPI:1043766272
Name:RANGEL, BLANCA (APRN)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 US HWY 75 S, SUITE 300
Mailing Address - Street 2:ATT BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:806-351-7510
Mailing Address - Fax:
Practice Address - Street 1:1411 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5555
Practice Address - Country:US
Practice Address - Phone:806-351-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130807364SF0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3624249-01Medicaid
TX3624249-01Medicaid