Provider Demographics
NPI:1811454648
Name:CARR, ANGELA RENEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:CARR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40850 HAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9004
Mailing Address - Country:US
Mailing Address - Phone:620-636-0249
Mailing Address - Fax:
Practice Address - Street 1:40850 HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718-9004
Practice Address - Country:US
Practice Address - Phone:620-636-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner