Provider Demographics
NPI:1780485177
Name:AGUDELO BETANCUR, MARIA CAMILA (APRN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CAMILA
Last Name:AGUDELO BETANCUR
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9121 BLAKELY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-1654
Mailing Address - Country:US
Mailing Address - Phone:817-846-7406
Mailing Address - Fax:
Practice Address - Street 1:895 N NOLAN RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-1250
Practice Address - Country:US
Practice Address - Phone:817-556-9700
Practice Address - Fax:817-556-9702
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1193503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily