Provider Demographics
NPI:1841646643
Name:HART, ANGELIA EZELL (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:EZELL
Last Name:HART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:247 CHATEAU DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6401
Mailing Address - Country:US
Mailing Address - Phone:256-882-1510
Mailing Address - Fax:256-217-5838
Practice Address - Street 1:247 CHATEAU DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6401
Practice Address - Country:US
Practice Address - Phone:256-882-1510
Practice Address - Fax:256-217-5838
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily