Provider Demographics
NPI:1447473483
Name:WHITE, ANGELA DEE (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000-18 HWY 17
Mailing Address - Street 2:44
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-304-2607
Mailing Address - Fax:
Practice Address - Street 1:514 LOS PALMAS DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8207
Practice Address - Country:US
Practice Address - Phone:904-304-2607
Practice Address - Fax:904-263-5381
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3298772363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health