Provider Demographics
NPI:1831991462
Name:RENTERIA, ANGELICA (DNP, PNP-PC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:
Credentials:DNP, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EXECUTIVE PARK DR NE APT 1120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2259
Mailing Address - Country:US
Mailing Address - Phone:832-339-3587
Mailing Address - Fax:
Practice Address - Street 1:311 ALCOVY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2139
Practice Address - Country:US
Practice Address - Phone:770-207-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN316689363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics