Provider Demographics
NPI:1467721894
Name:JENNIFER L ANGELO
Entity Type:Organization
Organization Name:JENNIFER L ANGELO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PMHNP
Authorized Official - Phone:903-767-1049
Mailing Address - Street 1:600 E COKE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3418
Mailing Address - Country:US
Mailing Address - Phone:903-342-9700
Mailing Address - Fax:903-342-9701
Practice Address - Street 1:600 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3418
Practice Address - Country:US
Practice Address - Phone:903-342-9700
Practice Address - Fax:903-342-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851676134OtherNPI TYPE 1