Provider Demographics
NPI:1134505993
Name:TIMMERMAN, ANGELICA LAUREN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:LAUREN
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:LAUREN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:772-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1856 THOMPSON BRIDGE RD STE 14
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1620
Practice Address - Country:US
Practice Address - Phone:770-219-9460
Practice Address - Fax:770-219-9461
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22593363LF0000X
GARN215693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003169456CMedicaid
GA003169456DMedicaid
GA04721916OtherAMERIGROUP