Provider Demographics
NPI:1659794451
Name:WAGGONER, ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:16107 KENSINGTON DR STE 126
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4224
Mailing Address - Country:US
Mailing Address - Phone:281-783-8162
Mailing Address - Fax:713-439-7995
Practice Address - Street 1:2560 E LEAGUE CITY PKWY
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6459
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:713-439-7995
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX848669363LF0000X
TXAP125075363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily