Provider Demographics
NPI:1558346213
Name:BRAY, ANGELA B (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:B
Last Name:BRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 CANDLEWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-0000
Mailing Address - Country:US
Mailing Address - Phone:850-549-1387
Mailing Address - Fax:
Practice Address - Street 1:8596 ORANGE AVENUE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534
Practice Address - Country:US
Practice Address - Phone:850-549-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102817363AM0700X
ALPA-377363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59177261OtherBLUE CROSS BLUE SHIELD
FL291980000Medicaid
AL891009260Medicaid
FL291980000Medicaid
AL59177261OtherBLUE CROSS BLUE SHIELD