Provider Demographics
NPI:1043634009
Name:HYLTON, ANGIE RUTH
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:RUTH
Last Name:HYLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:RUTH
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:284 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1602
Mailing Address - Country:US
Mailing Address - Phone:631-425-5250
Mailing Address - Fax:631-425-4197
Practice Address - Street 1:284 PULASKI RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1602
Practice Address - Country:US
Practice Address - Phone:631-425-5250
Practice Address - Fax:631-425-4197
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03879994Medicaid
NY00695941Medicaid
WI331952Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
NY03879994Medicaid
WI331954Medicare Oscar/Certification
WI331943Medicare Oscar/Certification