Healthcare Provider Details

I. General information

NPI: 1043473853
Provider Name (Legal Business Name): ANGELA CRICCHIO HULL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MICHELLE CRICCHIO DNP

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 BEACON ST
SOUTH SAN FRANCISCO CA
94080-6913
US

IV. Provider business mailing address

192 BEACON ST
SOUTH SAN FRANCISCO CA
94080-6913
US

V. Phone/Fax

Practice location:
  • Phone: 650-589-6500
  • Fax: 661-678-4534
Mailing address:
  • Phone: 650-589-6500
  • Fax: 661-678-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number654241
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: