Provider Demographics
NPI:1235376948
Name:TOUPS, ANGELITA MICHELLA (AD-NURSING)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:MICHELLA
Last Name:TOUPS
Suffix:
Gender:F
Credentials:AD-NURSING
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 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3721
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:900 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6720
Practice Address - Country:US
Practice Address - Phone:423-232-4130
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000052169164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse