Provider Demographics
NPI:1447540018
Name:TYMRAK, ANGELA M (LICAC, RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:TYMRAK
Suffix:
Gender:F
Credentials:LICAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:W FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02574-0841
Mailing Address - Country:US
Mailing Address - Phone:774-521-8213
Mailing Address - Fax:
Practice Address - Street 1:314 GIFFORD ST UNIT 4
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2945
Practice Address - Country:US
Practice Address - Phone:774-521-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist