Provider Demographics
NPI:1659086494
Name:UTA, ANGELA RENEE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:UTA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 ABINGTON WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8932
Mailing Address - Country:US
Mailing Address - Phone:714-822-9941
Mailing Address - Fax:
Practice Address - Street 1:8088 ABINGTON WOODS AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38002-8932
Practice Address - Country:US
Practice Address - Phone:714-822-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33136363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care