Provider Demographics
NPI:1649760695
Name:ORTIZ, ANGELICA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:ORTIZ
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 1:230 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5056
Mailing Address - Country:US
Mailing Address - Phone:903-957-0275
Mailing Address - Fax:903-957-0279
Practice Address - Street 1:230 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5056
Practice Address - Country:US
Practice Address - Phone:903-957-0275
Practice Address - Fax:903-957-0279
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner