Healthcare Provider Details

I. General information

NPI: 1477969889
Provider Name (Legal Business Name): ANGELA GARVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 11/27/2023
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST
NOBLESVILLE IN
46060
US

IV. Provider business mailing address

6626 E 75TH STE. 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-3434
  • Fax: 317-621-3430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28173986A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005064A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005064A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: