Provider Demographics
NPI:1114156585
Name:GUZMAN, ANGELICA R (NP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:R
Last Name:GUZMAN
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 1:11502 VALLEY PIKE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-0902
Mailing Address - Country:US
Mailing Address - Phone:281-797-0202
Mailing Address - Fax:281-596-4499
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:281-797-0202
Practice Address - Fax:281-596-4499
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684683363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX684683OtherLICENSE
TX204957902Medicaid
TXTXB113595Medicare PIN