Provider Demographics
NPI:1144795543
Name:GERRALD, ANGELA DARLENE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DARLENE
Last Name:GERRALD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:GERRALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1319 LEEFIELD STATION RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-6084
Mailing Address - Country:US
Mailing Address - Phone:912-481-9825
Mailing Address - Fax:
Practice Address - Street 1:11705 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1791
Practice Address - Country:US
Practice Address - Phone:912-819-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223095367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty