Provider Demographics
NPI:1285838987
Name:GODWIN, ANGELA MARIE (NP)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:GODWIN
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 1:12001 AVALON LAKE DR APT 326
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7379
Mailing Address - Country:US
Mailing Address - Phone:646-457-8127
Mailing Address - Fax:
Practice Address - Street 1:1469 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5846
Practice Address - Country:US
Practice Address - Phone:352-281-4863
Practice Address - Fax:347-824-2978
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335139-1363LF0000X
CT003941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V2401OtherHEALTH NET
CT203941OtherCONNECTICARE
CT06-1406459OtherTRICARE
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherPIONEER
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT06-1406459OtherMULTIPLAN
CT400085656CT01OtherANTHEM BCBS ON CT
CT06-1406459OtherPIONEER