Provider Demographics
NPI:1497183560
Name:BROWN, ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 E NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0773
Mailing Address - Country:US
Mailing Address - Phone:559-380-5733
Mailing Address - Fax:
Practice Address - Street 1:302 FRESNO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3600
Practice Address - Country:US
Practice Address - Phone:559-478-5988
Practice Address - Fax:559-478-5335
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089960Medicaid
ZZZ20843ZOtherMEDICARE ID-TYPE UNSPECIFIED
ZZZ02137ZOtherBLUE SHIELD
CAF64090Medicare UPIN