Provider Demographics
NPI:1629765581
Name:INGLE, ANGELA BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BROOKE
Last Name:INGLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15570 CAMINO DEL CERRO
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3720
Mailing Address - Country:US
Mailing Address - Phone:256-302-4302
Mailing Address - Fax:
Practice Address - Street 1:15570 CAMINO DEL CERRO
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3720
Practice Address - Country:US
Practice Address - Phone:256-302-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner