Provider Demographics
NPI:1649559998
Name:VINES, ANGIE MICHELLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MICHELLE
Last Name:VINES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 10TH AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3700
Mailing Address - Country:US
Mailing Address - Phone:706-653-4615
Mailing Address - Fax:
Practice Address - Street 1:2000 10TH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:706-653-4615
Practice Address - Fax:706-653-4618
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily