Provider Demographics
NPI:1992358980
Name:AQUILA, ANGELINA NICOLE
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:NICOLE
Last Name:AQUILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:NICOLE
Other - Last Name:PLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16873 SE DAVIDOFF WAY
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-5801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 SE 160TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8911
Practice Address - Country:US
Practice Address - Phone:360-882-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806506NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty