Healthcare Provider Details

I. General information

NPI: 1417709783
Provider Name (Legal Business Name): ANGELICA MARIE FIERRO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WESTERN TRAILS BLVD
AUSTIN TX
78745-1642
US

IV. Provider business mailing address

161 SHIRLEY DR
BUDA TX
78610-3675
US

V. Phone/Fax

Practice location:
  • Phone: 512-840-1273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1154509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: