Provider Demographics
NPI:1639347685
Name:CRONIN, ANGELA KARLINA (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KARLINA
Last Name:CRONIN
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 1:1550 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8322
Mailing Address - Country:US
Mailing Address - Phone:208-529-5942
Mailing Address - Fax:
Practice Address - Street 1:1760 N 200 E STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1202
Practice Address - Country:US
Practice Address - Phone:435-787-0560
Practice Address - Fax:435-752-4673
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant