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NPI Code Detail

MEDICARE: ANGELICA GHOLSTON NP

MEDICARE: ANGELICA GHOLSTON NP
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
1363LF0000XFamily Nurse PractitionerAP138759TX

General Provider Information

NPI Number : 1871064410
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA GHOLSTON NP
Provider Business Mailing Address
First Line : 2610 LAKE AUSTIN BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78703-4429
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 2610 LAKE AUSTIN BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78703-4429
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2018
Last Update Date : 03/18/2021

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