Provider Demographics
NPI:1114424942
Name:WIGGINS, ANGELA M (APRN CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 S UTICA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5346
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-868-2944
Practice Address - Street 1:1500 E DOWNING ST STE 214
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-413-0202
Practice Address - Fax:918-413-0203
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0075741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily