Provider Demographics
NPI:1245580414
Name:ADAMS, ANGELA D (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-621-0671
Mailing Address - Fax:
Practice Address - Street 1:120 E CARTER AVE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1561
Practice Address - Country:US
Practice Address - Phone:912-449-4426
Practice Address - Fax:912-449-1059
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158173174400000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300027669BMedicaid