Healthcare Provider Details

I. General information

NPI: 1851098123
Provider Name (Legal Business Name): ANGELA NICOLE JENNINGS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 W WENDOVER AVE STE D
GREENSBORO NC
27407-1584
US

IV. Provider business mailing address

4015 BOW CT
BURLINGTON NC
27215-9497
US

V. Phone/Fax

Practice location:
  • Phone: 336-589-1223
  • Fax: 888-815-0892
Mailing address:
  • Phone: 434-429-6235
  • Fax: 336-859-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296818
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG06230007
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: