Provider Demographics
NPI:1174851745
Name:TYUS, ANGELA FRANCES (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FRANCES
Last Name:TYUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 WHEAT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4360
Mailing Address - Country:US
Mailing Address - Phone:229-243-8462
Mailing Address - Fax:229-243-8714
Practice Address - Street 1:603 WHEAT AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4360
Practice Address - Country:US
Practice Address - Phone:229-243-8462
Practice Address - Fax:229-243-8714
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143534363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100084AMedicaid
GA003100084AMedicaid