Provider Demographics
NPI:1548018849
Name:BALTAZAR, ABIGAIL NICOLE (MSN, APRN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NICOLE
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:NICOLE
Other - Last Name:BALTAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2753 PANZANO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6853
Mailing Address - Country:US
Mailing Address - Phone:713-530-1498
Mailing Address - Fax:
Practice Address - Street 1:712 TEXAS AVENUE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-772-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6858207RI0011X
TX1158837363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology