Provider Demographics
NPI:1821558347
Name:CARLSON, ANGELA J (CPNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21442 FLEET LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7223
Mailing Address - Country:US
Mailing Address - Phone:714-225-9189
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE STE 802
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7784
Practice Address - Country:US
Practice Address - Phone:949-644-0970
Practice Address - Fax:949-644-0774
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011049363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics