Provider Demographics
NPI:1437697190
Name:FRAZIER, ANGELA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2500
Mailing Address - Country:US
Mailing Address - Phone:229-244-6852
Mailing Address - Fax:229-242-2385
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1785
Practice Address - Country:US
Practice Address - Phone:229-433-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN291250367500000X
MARN2390543367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered