Provider Demographics
NPI:1285823344
Name:GRIMALDO, ANGELA H (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:H
Last Name:GRIMALDO
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 1:2612 HARWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-8309
Mailing Address - Country:US
Mailing Address - Phone:817-571-8912
Mailing Address - Fax:817-571-8916
Practice Address - Street 1:2612 HARWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-8309
Practice Address - Country:US
Practice Address - Phone:817-571-8912
Practice Address - Fax:817-571-8916
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193396201Medicaid
TX8K5946Medicare PIN