Provider Demographics
NPI:1023323680
Name:CHAMPION, ANGELA MARIA (FP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIA
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MARY ESTHER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1967
Mailing Address - Country:US
Mailing Address - Phone:850-301-0677
Mailing Address - Fax:
Practice Address - Street 1:71 MARY ESTHER BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1967
Practice Address - Country:US
Practice Address - Phone:850-301-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily