Provider Demographics
NPI:1396272159
Name:STOLTZ, ANGELICA (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1802
Mailing Address - Country:US
Mailing Address - Phone:651-363-2162
Mailing Address - Fax:
Practice Address - Street 1:1350 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1802
Practice Address - Country:US
Practice Address - Phone:651-363-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5170363LF0000X
MN1986343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1986343OtherREGISTERED NURSE LICENSE
MN5170OtherAPRN LICENSE
MN1396272159OtherNPI