Provider Demographics
NPI:1528495033
Name:BLANKS, ANGELA NICOLE (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NICOLE
Last Name:BLANKS
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OYSTER CREEK DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4119
Mailing Address - Country:US
Mailing Address - Phone:979-215-2309
Mailing Address - Fax:844-272-3168
Practice Address - Street 1:135 OYSTER CREEK DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4119
Practice Address - Country:US
Practice Address - Phone:979-215-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139689363LF0000X
TX717041163WM0102X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4828957Medicaid