Provider Demographics
NPI:1053834705
Name:THOMAS, ANGELA AMICK (FNP-C, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:AMICK
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C, AGACNP-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:AMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, AGACNP-BC
Mailing Address - Street 1:21614 SC HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:WHITMIRE
Mailing Address - State:SC
Mailing Address - Zip Code:29178-9410
Mailing Address - Country:US
Mailing Address - Phone:803-917-2496
Mailing Address - Fax:
Practice Address - Street 1:2605 KINARD ST STE 105
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2965
Practice Address - Country:US
Practice Address - Phone:803-321-6254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily