Provider Demographics
NPI:1699007880
Name:DEBRUHL, ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DEBRUHL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PEARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4214 HARD SCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8560
Mailing Address - Country:US
Mailing Address - Phone:803-477-4733
Mailing Address - Fax:
Practice Address - Street 1:4214 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8560
Practice Address - Country:US
Practice Address - Phone:803-477-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP30302Medicare UPIN