Provider Demographics
NPI:1760419295
Name:BREWER, ANGELA P (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:P
Last Name:BREWER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:9333 PARK WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4317
Practice Address - Country:US
Practice Address - Phone:865-531-4600
Practice Address - Fax:865-690-2271
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00289115OtherRR MEDICARE
TN3348257Medicaid
TN3706638Medicare ID - Type UnspecifiedLEGACY GROUP
TN3348257Medicaid
TNP00289115OtherRR MEDICARE