Provider Demographics
NPI:1376104257
Name:WINBUSH, ANGELA W (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:W
Last Name:WINBUSH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:DIONE
Other - Last Name:WINBUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:10808 FALL CREEK DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1392
Mailing Address - Country:US
Mailing Address - Phone:904-210-6127
Mailing Address - Fax:
Practice Address - Street 1:10808 FALL CREEK DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1392
Practice Address - Country:US
Practice Address - Phone:904-210-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3143852163WC0200X
FL11003085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine