Provider Demographics
NPI:1801392816
Name:BERMUDEZ, ANGELIQUE CLAIRE (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:CLAIRE
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S YEARLING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2800
Mailing Address - Country:US
Mailing Address - Phone:614-701-9080
Mailing Address - Fax:
Practice Address - Street 1:675 S YEARLING RD STE 100
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2800
Practice Address - Country:US
Practice Address - Phone:614-701-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023216363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily