Provider Demographics
NPI:1538120266
Name:PERRIN, ANGELA HARTMAN (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HARTMAN
Last Name:PERRIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO ROAD
Mailing Address - Street 2:DIVISION OF CARDIOLOGY , DAVIS 7B EAST
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:904-953-2911
Practice Address - Street 1:4500 SAN PABLO ROAD
Practice Address - Street 2:DAVIS 7B-EAST
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:904-953-2911
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3072975-00Medicaid
FLBN105ZMedicare PIN