Provider Demographics
NPI:1730361635
Name:NOLEN, ANGELA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:NOLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4135
Mailing Address - Country:US
Mailing Address - Phone:830-625-3999
Mailing Address - Fax:
Practice Address - Street 1:921 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4135
Practice Address - Country:US
Practice Address - Phone:830-625-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA05474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282224901Medicaid
TX282111801Medicaid
TX282111802Medicaid
TXTXB123987Medicare PIN
TXTXB123985Medicare PIN
TX282224901Medicaid