Provider Demographics
NPI:1205337102
Name:TAVOLACCI, ANGELA (BSNS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:TAVOLACCI
Suffix:
Gender:F
Credentials:BSNS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5914 WESTCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1139
Mailing Address - Country:US
Mailing Address - Phone:269-277-3795
Mailing Address - Fax:
Practice Address - Street 1:5914 WESTCHESTER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1139
Practice Address - Country:US
Practice Address - Phone:269-277-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education