Healthcare Provider Details

I. General information

NPI: 1972020543
Provider Name (Legal Business Name): ANGJELIN SHTJEFNI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 US HIGHWAY 82 W STE 5
TIFTON GA
31793-8213
US

IV. Provider business mailing address

PO BOX 5610
CORDELE GA
31010-5610
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9394327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: