Provider Demographics
NPI:1851631089
Name:FORD, ANGELA DIANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANNE
Last Name:FORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2825
Mailing Address - Country:US
Mailing Address - Phone:409-983-1161
Mailing Address - Fax:409-982-0978
Practice Address - Street 1:2548 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2825
Practice Address - Country:US
Practice Address - Phone:409-983-1161
Practice Address - Fax:409-982-0978
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily