Provider Demographics
NPI:1104157130
Name:VAUGHN, ANGELA TAYLOR (MSN, APRN, NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TAYLOR
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 YUCCA FLATS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-8333
Mailing Address - Country:US
Mailing Address - Phone:817-584-2940
Mailing Address - Fax:
Practice Address - Street 1:4633 YUCCA FLATS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-8333
Practice Address - Country:US
Practice Address - Phone:817-584-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680779163WN0002X
TXAP118893363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care