Provider Demographics
NPI:1023212339
Name:CALVERT, ANGELA M (NP)
Entity Type:Individual
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First Name:ANGELA
Middle Name:M
Last Name:CALVERT
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Gender:F
Credentials:NP
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Mailing Address - Street 1:200 S. ENOTA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3466
Mailing Address - Country:US
Mailing Address - Phone:770-534-2020
Mailing Address - Fax:770-297-3552
Practice Address - Street 1:200 S. ENOTA DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3466
Practice Address - Country:US
Practice Address - Phone:770-534-2020
Practice Address - Fax:770-297-3552
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-05-17
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Provider Licenses
StateLicense IDTaxonomies
GARN221721363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
021889M65Medicare PIN