Provider Demographics
NPI:1336864974
Name:O'TOOLE, ANGELINA
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1364 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2485
Practice Address - Country:US
Practice Address - Phone:609-836-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01379200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology