Provider Demographics
NPI:1548225584
Name:BROWN, ANGELA C (DNP, FNP-BC, ANP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:DNP, FNP-BC, ANP-BC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CAROL
Other - Last Name:COUNTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:380 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3985
Mailing Address - Country:US
Mailing Address - Phone:520-507-9040
Mailing Address - Fax:
Practice Address - Street 1:380 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3985
Practice Address - Country:US
Practice Address - Phone:520-507-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5424363L00000X, 363LF0000X
MI4704186457363L00000X
AZAP2645363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00.74283OtherRR MEDICARE
MI104920510Medicaid
AZ210313Medicaid
MI104849907Medicaid
AZZ166066Medicare PIN
MIQ69735Medicare UPIN
Q69735Medicare UPIN
MIM73310029Medicare PIN