Provider Demographics
NPI:1821395559
Name:ANGLE, VIRGINIA LORRAINE (ARNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LORRAINE
Last Name:ANGLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LORRAINE
Other - Last Name:GULLOTTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-4960
Mailing Address - Fax:850-416-4961
Practice Address - Street 1:4501 N DAVIS HWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2724
Practice Address - Country:US
Practice Address - Phone:850-416-4960
Practice Address - Fax:850-416-4961
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069585363LF0000X
FLARNP9372812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily