Provider Demographics
NPI:1114053816
Name:ABBOTT, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-0156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5885 BRADFORD HICKS DRIVE
Practice Address - Street 2:TN DEPT OF HEALTH
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570
Practice Address - Country:US
Practice Address - Phone:931-823-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse