Provider Demographics
NPI:1134160070
Name:ANGULO-BARTLETT, TRICIA K (CRNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:K
Last Name:ANGULO-BARTLETT
Suffix:
Gender:F
Credentials:CRNP
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 21182
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-0682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3826
Practice Address - Country:US
Practice Address - Phone:410-744-8822
Practice Address - Fax:410-744-5117
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149461363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0023OtherBCBS BLUECHOICE
MD642391-01OtherBCBS (MD)
MD404074100Medicaid
MDQ14166Medicare UPIN
MDK519Q341Medicare PIN
DC0023OtherBCBS BLUECHOICE