Provider Demographics
NPI:1710522040
Name:ESTRADA, ANGELITA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:
Last Name:ESTRADA
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 1:3939 MEDICAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2292
Mailing Address - Country:US
Mailing Address - Phone:210-450-6120
Mailing Address - Fax:210-450-6161
Practice Address - Street 1:161 E RIVULON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0087
Practice Address - Country:US
Practice Address - Phone:480-494-2465
Practice Address - Fax:480-534-4087
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141972363LP2300X
AZ254158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407836201Medicaid
TX407836202OtherCSHCN