Provider Demographics
NPI:1134598659
Name:FOUNTAIN, ANGELA MICHELE (NP-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MICHELE
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MICHELE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 KEMPSVILLE RD 2B223
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-8860
Mailing Address - Fax:757-689-2420
Practice Address - Street 1:830 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner