Provider Demographics
NPI:1386211076
Name:ANGLIN, AMY P (PNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:P
Other - Last Name:LARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5565 W LAS POSITAS BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5807
Mailing Address - Country:US
Mailing Address - Phone:925-460-8444
Mailing Address - Fax:925-460-8565
Practice Address - Street 1:5565 W LAS POSITAS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5807
Practice Address - Country:US
Practice Address - Phone:925-460-8444
Practice Address - Fax:925-460-8565
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95107155163WP0200X
CA95017254363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics