MEDICARE: ANGELA LATRICE CRAWFORD PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP110347	TX

General Provider Information

NPI Number	:	1104541200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LATRICE CRAWFORD PNP

Provider Business Mailing Address
First Line	:	6909 BRISBANE CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7145
Country	:	US
Telephone Number	:	832-222-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 BRISBANE CT STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7146
Country	:	US
Telephone Number	:	832-222-5437
Fax Number	:	832-222-5438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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