Provider Demographics
NPI:1265802227
Name:GOULD, ANGELA LEIGH (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEIGH
Last Name:GOULD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEIGH
Other - Last Name:WICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:767 TWIN WILLOW DR APT 106
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0098
Mailing Address - Country:US
Mailing Address - Phone:813-545-6597
Mailing Address - Fax:
Practice Address - Street 1:222 HERLONG AVE S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-329-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-03
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2944902363LA2200X
SC25023.APN.RX363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health