Provider Demographics
NPI:1114277944
Name:WHITE, ANGELA J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 RIVERCHASE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7490
Mailing Address - Country:US
Mailing Address - Phone:334-448-9505
Mailing Address - Fax:334-448-9575
Practice Address - Street 1:5009 RIVERCHASE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7490
Practice Address - Country:US
Practice Address - Phone:334-448-9505
Practice Address - Fax:334-448-9575
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-074021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-074021OtherSTATE OF ALABAMA NURSE PRACTITIONER LICENSE