Provider Demographics
NPI:1659506848
Name:DEKLE, ANGELYN A (APRN, BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELYN
Middle Name:A
Last Name:DEKLE
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-5970
Mailing Address - Fax:912-350-3374
Practice Address - Street 1:4750 WATERS AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6268
Practice Address - Country:US
Practice Address - Phone:912-350-5970
Practice Address - Fax:912-350-3374
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN111994363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily