Provider Demographics
NPI:1952811465
Name:GIMOSE, ANGELA V (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:V
Last Name:GIMOSE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 HEARTHSIDE WAY UNIT 1036
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7365
Mailing Address - Country:US
Mailing Address - Phone:443-858-8126
Mailing Address - Fax:
Practice Address - Street 1:3300 BRIGGS CHANEY RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4811
Practice Address - Country:US
Practice Address - Phone:301-493-2400
Practice Address - Fax:240-235-7075
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF07171190OtherCERTIFICATION NUMBER
MDR197579OtherLISENCE NUMBER