Provider Demographics
NPI:1083886014
Name:ANGLIN, AILEEN HARGRODER (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:HARGRODER
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:HARGRODER
Other - Last Name:BRASSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05445363LA2100X
TXAP128243363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380118501Medicaid
TX380118503OtherCSHCN
MS04435244Medicaid
TX380118502Medicaid
LA265173YJXSOtherMEDICARE