Provider Demographics
NPI:1063815652
Name:BLISS, ANGELA (CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BLISS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3618
Mailing Address - Country:US
Mailing Address - Phone:330-225-8886
Mailing Address - Fax:330-741-7097
Practice Address - Street 1:3574 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3618
Practice Address - Country:US
Practice Address - Phone:303-225-8886
Practice Address - Fax:330-741-7097
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16563363LF0000X
OH16563-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily