Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP134870 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP134870 | TX |
NPI | 1003332438 |
---|---|
Provider Name | Angela Maria Tanguma |
First Address | Edinburg, TX 78539-1803 |
Second Address | Edinburg, TX 78539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
385897901 | (05) | TX |
H08JU15201 | BCBS (01) | TX |