Healthcare Provider Details

I. General information

NPI: 1760816656
Provider Name (Legal Business Name): ANGELA M. POLLOCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA BIDDLE

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S. MAIN STREET, SUITE 101 SMYRNA HEALTH & WELLNESS CENTER
SMYRNA DE
19977-1478
US

IV. Provider business mailing address

200 HYGEIA DRIVE, SUITE 2300 CCHS PHYSICIAN CONTRACTING
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-659-4444
  • Fax: 302-659-4495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001185
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000659
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: