Provider Demographics
NPI:1578129540
Name:NGO, ANNIE SO (FNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:SO
Last Name:NGO
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 1:1008 RANCH ROAD 620 S
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5633
Mailing Address - Country:US
Mailing Address - Phone:512-263-9072
Mailing Address - Fax:512-402-9057
Practice Address - Street 1:1008 RANCH ROAD 620 S STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5633
Practice Address - Country:US
Practice Address - Phone:512-263-9072
Practice Address - Fax:512-402-9057
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily