Provider Demographics
NPI:1093895518
Name:BURT, ANGIE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:MARIE
Last Name:BURT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406
Mailing Address - Country:US
Mailing Address - Phone:540-848-6654
Mailing Address - Fax:703-858-3529
Practice Address - Street 1:9 CENTER STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556
Practice Address - Country:US
Practice Address - Phone:540-288-2222
Practice Address - Fax:703-858-3529
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily