Provider Demographics
NPI:1669661070
Name:HAGUE, ANGELA RENE (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENE
Last Name:HAGUE
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:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-1810
Mailing Address - Country:US
Mailing Address - Phone:828-575-2644
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B332
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6822
Practice Address - Country:US
Practice Address - Phone:972-566-7788
Practice Address - Fax:972-566-8837
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03936363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408468ZM3LOtherMEDICARE PTAN
TX408468ZM3JOtherMEDICARE PTAN
TX190057301Medicaid
TXTXB114330OtherMEDICARE PTAN
TX408468ZM3JOtherMEDICARE PTAN
TX8K2730Medicare UPIN