Provider Demographics
NPI:1790479152
Name:CRISCITIELLO, PAMELA PROCTOR (AGPCNP, MSN, RN, OCN)
Entity Type:Individual
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First Name:PAMELA
Middle Name:PROCTOR
Last Name:CRISCITIELLO
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Gender:F
Credentials:AGPCNP, MSN, RN, OCN
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Mailing Address - Street 1:812 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4460
Mailing Address - Country:US
Mailing Address - Phone:305-298-8973
Mailing Address - Fax:
Practice Address - Street 1:2215 E VILLA MARIA RD STE 110
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2585
Practice Address - Country:US
Practice Address - Phone:979-776-2000
Practice Address - Fax:979-776-0427
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAG05230129363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health