Provider Demographics
NPI:1275148793
Name:AGNELLO, BIANCA ADRIANNA (FNP-C)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ADRIANNA
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 BOAT CLUB RD
Mailing Address - Street 2:STE 115
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3676
Mailing Address - Country:US
Mailing Address - Phone:512-799-5366
Mailing Address - Fax:
Practice Address - Street 1:8465 BOAT CLUB RD STE 115
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3676
Practice Address - Country:US
Practice Address - Phone:817-260-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily