MEDICARE: ANGELA WINDOM O'DONNELL APRN, CNM, WHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	9337495	FL
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP9337495	FL
3	367A00000X	Advanced Practice Midwife
4	363LP2300X	Primary Care Nurse Practitioner	99337495	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033540463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WINDOM O'DONNELL APRN, CNM, WHNP-BC

Provider Business Mailing Address
First Line	:	86132 MEADOWRIDGE CT STE 240
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-6432
Country	:	US
Telephone Number	:	770-301-5834
Fax Number	:

Provider Business Practice Location Address
First Line	:	22455 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-452-4790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	03/17/2023

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