Healthcare Provider Details

I. General information

NPI: 1447338603
Provider Name (Legal Business Name): ANGELA RENEE POOL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 US HIGHWAY 331 S
DEFUNIAK SPRINGS FL
32435-6307
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 850-951-4556
  • Fax: 850-951-4527
Mailing address:
  • Phone: 417-256-9111
  • Fax: 417-257-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012186
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR0072345
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: