Provider Demographics
NPI:1619984390
Name:HARBIN, ANGEL S, (CFNP)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:S,
Last Name:HARBIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802
Mailing Address - Country:US
Mailing Address - Phone:662-678-1050
Mailing Address - Fax:662-678-1067
Practice Address - Street 1:149 N EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804
Practice Address - Country:US
Practice Address - Phone:662-678-1050
Practice Address - Fax:662-678-1067
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR697621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121401Medicaid
MS0121401Medicaid
S92706Medicare UPIN
500001563Medicare ID - Type Unspecified