Provider Demographics
NPI:1760845911
Name:WELKE, ANGELA MARIE (PA-C, MS, ATC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:WELKE
Suffix:
Gender:F
Credentials:PA-C, MS, ATC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:PECTOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MS, ATC
Mailing Address - Street 1:2235 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3390
Mailing Address - Country:US
Mailing Address - Phone:321-615-6762
Mailing Address - Fax:
Practice Address - Street 1:12385 SORRENTO RD STE A4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8656
Practice Address - Country:US
Practice Address - Phone:850-466-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant