Provider Demographics
NPI:1023284601
Name:JANSSEN, ANGELISA JANIKKE (MD)
Entity type:Individual
Prefix:
First Name:ANGELISA
Middle Name:JANIKKE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E MAIN ST STE D
Mailing Address - Street 2:STE 193
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3952
Mailing Address - Country:US
Mailing Address - Phone:615-752-0041
Mailing Address - Fax:
Practice Address - Street 1:170 E MAIN ST STE D
Practice Address - Street 2:STE 193
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3952
Practice Address - Country:US
Practice Address - Phone:615-752-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine