Provider Demographics
NPI:1912217662
Name:GEORGE, ANGELA MARDINE (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARDINE
Last Name:GEORGE
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Gender:F
Credentials:WHNP-BC
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Mailing Address - Street 1:4312 HERITAGE TRACE PKWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9132
Mailing Address - Country:US
Mailing Address - Phone:817-741-9663
Mailing Address - Fax:817-741-3691
Practice Address - Street 1:4312 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9132
Practice Address - Country:US
Practice Address - Phone:817-741-9663
Practice Address - Fax:817-741-3691
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX684632363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health