Provider Demographics
NPI:1578308565
Name:RAABE, ANGELYN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELYN
Middle Name:
Last Name:RAABE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 BRAIDWOOD RUN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3534
Mailing Address - Country:US
Mailing Address - Phone:678-492-0887
Mailing Address - Fax:
Practice Address - Street 1:148 BILL CARRUTH PKWY STE 260
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3756
Practice Address - Country:US
Practice Address - Phone:470-956-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA239493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner