Provider Demographics
NPI:1568017663
Name:QUIROZ, ANGELITA REYES (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELITA
Middle Name:REYES
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ELLAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31806-0065
Mailing Address - Country:US
Mailing Address - Phone:229-931-8680
Mailing Address - Fax:229-937-2232
Practice Address - Street 1:339 S BROAD ST
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806-3304
Practice Address - Country:US
Practice Address - Phone:229-931-8680
Practice Address - Fax:229-937-2232
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner