Provider Demographics
NPI:1902211337
Name:VODRASKA, ANGELA (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:VODRASKA
Suffix:
Gender:F
Credentials:APRN
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:1631 LANCASTER DR
Practice Address - Street 2:STE. 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3585
Practice Address - Country:US
Practice Address - Phone:817-251-9080
Practice Address - Fax:817-251-9082
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01887047OtherRAILROAD
TXP01887047OtherRAILROAD
TX344017403Medicaid
TX360377YKPWMedicare PIN
TX360377YKQLMedicare PIN