Healthcare Provider Details

I. General information

NPI: 1932288834
Provider Name (Legal Business Name): ANGELA SINOPOLI MOCK CRN7A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 PAULSEN STREET
SAVANNAH GA
31416
US

IV. Provider business mailing address

PO BOX 13647 5311 PAULSEN STREET
SAVANNAH GA
31416
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-7766
  • Fax: 912-692-0985
Mailing address:
  • Phone: 912-355-7766
  • Fax: 912-692-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN066820
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: