Provider Demographics
NPI:1356137947
Name:PENA, ANGELA NICHOLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICHOLE
Last Name:PENA
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W CROCKETT
Mailing Address - Street 2:
Mailing Address - City:DRISCOLL
Mailing Address - State:TX
Mailing Address - Zip Code:78351
Mailing Address - Country:US
Mailing Address - Phone:361-947-2814
Mailing Address - Fax:
Practice Address - Street 1:421 W CROCKETT
Practice Address - Street 2:
Practice Address - City:DRISCOLL
Practice Address - State:TX
Practice Address - Zip Code:78351
Practice Address - Country:US
Practice Address - Phone:361-947-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker