Provider Demographics
NPI:1033540463
Name:O'DONNELL, ANGELA WINDOM (APRN, CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:WINDOM
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JONE
Other - Last Name:WINDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNM, WHNP-BC
Mailing Address - Street 1:86132 MEADOWRIDGE CT STE 240
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6432
Mailing Address - Country:US
Mailing Address - Phone:770-301-5834
Mailing Address - Fax:
Practice Address - Street 1:22455 FLORA PARKE XING
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8000
Practice Address - Country:US
Practice Address - Phone:904-452-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9337495363LW0102X
FLARNP9337495363LX0001X
367A00000X
FL99337495363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife