Provider Demographics
NPI:1508487398
Name:PADOLINA, MARK ANGELO (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANGELO
Last Name:PADOLINA
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OSHKOSH AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3810
Mailing Address - Country:US
Mailing Address - Phone:806-470-7798
Mailing Address - Fax:
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-9011
Practice Address - Fax:806-761-0620
Is Sole Proprietor?:No
Enumeration Date:2020-05-03
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014441363LF0000X
TXAP143471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily