Provider Demographics
NPI:1164908042
Name:GIRARD, ANGIE MAE (FNP, RN)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:MAE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MAE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:350 BON AIR CTR STE 200
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3000
Practice Address - Country:US
Practice Address - Phone:415-578-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95159758163W00000X
CORN.1664451163W00000X
COAPN.0995227-NP363LF0000X
CA95010151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse