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General NPI Number Information
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NPI Number | 1912217662
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Entity Type | Individual
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Provider Name | ANGELA MARDINE GEORGE WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 10600 N RIVERSIDE DR STE 100
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City | FORT WORTH
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State | TX
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Zip | 76244-9505
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Country | US
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Telephone | 817-741-9663
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 HERITAGE TRACE PKWY SUITE 700
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City | FORT WORTH
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State | TX
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Zip | 76244-9132
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Country | US
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Telephone | 817-741-9663
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Fax | 817-741-3691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 684632
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License Number State | TX
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