Provider Demographics
NPI:1497739429
Name:TIPTON, ANGA-LEE MORGAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGA-LEE
Middle Name:MORGAN
Last Name:TIPTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGA-LEE
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4000 VILLAGE VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506
Mailing Address - Country:US
Mailing Address - Phone:678-450-3000
Mailing Address - Fax:678-450-1527
Practice Address - Street 1:4000 VILLAGE VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506
Practice Address - Country:US
Practice Address - Phone:678-450-3000
Practice Address - Fax:678-450-1527
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000791579CMedicaid
GA676383OtherWELLCARE
GA000791579EMedicaid
GA01305770OtherAMERIGROUP
GA532605OtherWELLCARE
GA000791579DMedicaid
GA000791579DMedicaid
GA05BBJCNMedicare ID - Type Unspecified
GA202I501198Medicare PIN