Provider Demographics
NPI:1619097375
Name:RICHARD-EAGLIN, ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICHARD-EAGLIN
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 1:231 LONGBOW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6451
Mailing Address - Country:US
Mailing Address - Phone:225-272-6606
Mailing Address - Fax:
Practice Address - Street 1:231 LONGBOW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6451
Practice Address - Country:US
Practice Address - Phone:225-272-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622346Medicare UPIN