Healthcare Provider Details

I. General information

NPI: 1407441751
Provider Name (Legal Business Name): ANGELA D SKOUSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAIN ST
BRISTOW OK
74010-2410
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-6533
  • Fax:
Mailing address:
  • Phone: 800-480-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200530
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: