Provider Demographics
NPI:1720021843
Name:MIXON, ANGELA BARTON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BARTON
Last Name:MIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:310 EISENHOWER DR STE 12A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-201-1140
Mailing Address - Fax:912-352-4065
Practice Address - Street 1:310 EISENHOWER DR STE 12A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-201-1140
Practice Address - Fax:912-352-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59263Medicare UPIN