Individual
ANGELA THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGPCNP-BC
Contact information
Practice address
122 W COLORADO BLVD, DALLAS, TX 75208-2382
(214) 947-6700
Mailing address
122 W COLORADO BLVD, DALLAS, TX 75208-2382
(214) 947-6700
(214) 947-6701
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1194745
TX
363LG0600X
Gerontology Nurse Practitioner
1194745
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
1194745
TX
Other
Enumeration date
06/11/2025
Last updated
10/02/2025
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