Provider Demographics
NPI:1780964254
Name:PLICHTA, ANGELA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:PLICHTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 LONGLEAF PINE CIR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4400
Mailing Address - Country:US
Mailing Address - Phone:305-878-8887
Mailing Address - Fax:
Practice Address - Street 1:1905 GLEN MEADE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6024
Practice Address - Country:US
Practice Address - Phone:910-763-6251
Practice Address - Fax:910-763-7408
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14353363A00000X
FLPA9106116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty