Healthcare Provider Details

I. General information

NPI: 1154592764
Provider Name (Legal Business Name): ANGELA NUNZIA FONTANA MSN,ANP,CNS,CEN,ONC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2008
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 HARD SCRABBLE RD
COLUMBIA SC
29229-8561
US

IV. Provider business mailing address

4531 HARD SCRABBLE RD
COLUMBIA SC
29229-8561
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-2140
  • Fax:
Mailing address:
  • Phone: 803-419-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2328
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: