Provider Demographics
NPI:1316648132
Name:GERONIMO, ANGELIQUE ABIGAIL (FNP-BC, RN)
Entity type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:ABIGAIL
Last Name:GERONIMO
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:901 W BEN WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2778
Practice Address - Country:US
Practice Address - Phone:512-341-0900
Practice Address - Fax:512-341-2895
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX971142163WM0705X
TX1113186363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily