Provider Demographics
NPI:1932091550
Name:ANGULO, TINA EILEEN (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:EILEEN
Last Name:ANGULO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W HEATHERBRAE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5110
Mailing Address - Country:US
Mailing Address - Phone:623-256-0040
Mailing Address - Fax:
Practice Address - Street 1:1950 W HEATHERBRAE DR STE 10
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5110
Practice Address - Country:US
Practice Address - Phone:023-366-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse