Provider Demographics
NPI:1629705256
Name:HERRERA, ANGELINA (PA)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WASHINGTON SQ APT A
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-4244
Mailing Address - Country:US
Mailing Address - Phone:708-942-9136
Mailing Address - Fax:
Practice Address - Street 1:4885 HOFFMAN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3727
Practice Address - Country:US
Practice Address - Phone:847-255-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant