Provider Demographics
NPI:1174846349
Name:PIERCE, ANGELINA (NP)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:PIERCE
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 1:891 E VICS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6327
Mailing Address - Country:US
Mailing Address - Phone:801-541-4076
Mailing Address - Fax:801-829-9836
Practice Address - Street 1:891 E VICS RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-6327
Practice Address - Country:US
Practice Address - Phone:801-541-4076
Practice Address - Fax:801-829-9836
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT193339-4405363LP2300X
UT19339-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care