Provider Demographics
NPI:1720759301
Name:REENTS, ANGELA RAE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RAE
Last Name:REENTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W BETHEL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4476
Mailing Address - Country:US
Mailing Address - Phone:972-393-4726
Mailing Address - Fax:
Practice Address - Street 1:413 W BETHEL RD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4476
Practice Address - Country:US
Practice Address - Phone:972-393-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF09210458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty