Provider Demographics
NPI:1831411081
Name:YOUNGBLOOD, ANGELA SAMUEL (RN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:SAMUEL
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7001 SAINT ANDREWS RD # 342
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-800-4520
Mailing Address - Fax:803-749-4305
Practice Address - Street 1:7001 SAINT ANDREWS RD # 342
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1137
Practice Address - Country:US
Practice Address - Phone:803-800-4520
Practice Address - Fax:803-749-4305
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse