Healthcare Provider Details

I. General information

NPI: 1134160070
Provider Name (Legal Business Name): TRICIA K ANGULO-BARTLETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N ROLLING RD
CATONSVILLE MD
21228-3826
US

IV. Provider business mailing address

PO BOX 21182
BALTIMORE MD
21228-0682
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-8822
  • Fax: 410-744-5117
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR149461
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: