Provider Demographics
NPI:1710437702
Name:SAXON, ANGELA DENISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:SAXON
Suffix:
Gender:F
Credentials:FNP-BC
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:437-777-4908
Mailing Address - Fax:843-777-7480
Practice Address - Street 1:101 S RAVENEL ST STE 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2621
Practice Address - Country:US
Practice Address - Phone:843-777-7490
Practice Address - Fax:843-777-7480
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4758Medicaid
SCNAOtherNA