Healthcare Provider Details

I. General information

NPI: 1417264292
Provider Name (Legal Business Name): ANGELA MARIE BARCO MSN, ARNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANGELA MARIE MONTECINO

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3486 PEACH ORCHARD RD STE 200
AUGUSTA GA
30906
US

IV. Provider business mailing address

PO BOX 1705
AUGUSTA GA
30903-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-828-8049
  • Fax: 706-828-8048
Mailing address:
  • Phone: 706-854-6917
  • Fax: 706-774-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberRN2211722
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN221722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: