Provider Demographics
NPI:1386870814
Name:BERKOWITZ, ANGELIA COLWELL (RN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:COLWELL
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:DAWN
Other - Last Name:COLWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:PO BOX 65057
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-5057
Mailing Address - Country:US
Mailing Address - Phone:210-299-8000
Mailing Address - Fax:210-616-9901
Practice Address - Street 1:12705 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3257
Practice Address - Country:US
Practice Address - Phone:210-599-0922
Practice Address - Fax:210-616-9901
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00950828OtherRR MEDICARE
TX8L22803Medicare PIN