MEDICARE: MISS ANGELA JO COOK APRN

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	363LF0000X	Family Nurse Practitioner	107135	OK

General Provider Information

NPI Number	:	1275178139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELA JO COOK APRN

Provider Business Mailing Address
First Line	:	3903 RIVERSIDE DR APT 35
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3057
Country	:	US
Telephone Number	:	918-904-9091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 RIVERSIDE DR APT 35
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3057
Country	:	US
Telephone Number	:	918-904-9091
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	02/25/2026

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