Provider Demographics
NPI:1932480365
Name:MARTIN, ANGELA S (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:MARTIN
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 1:9300 MANSFIELD RD STE 209
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3138
Mailing Address - Country:US
Mailing Address - Phone:318-779-1282
Mailing Address - Fax:866-984-3919
Practice Address - Street 1:9300 MANSFIELD RD STE 209
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3138
Practice Address - Country:US
Practice Address - Phone:318-779-1282
Practice Address - Fax:866-984-3919
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1212206655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily