Healthcare Provider Details

I. General information

NPI: 1629418439
Provider Name (Legal Business Name): ANGELA MARIE WARREN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARIE WARREN FNP

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 CORPORATE WOODS DR SUITE 200
VIRGINIA BEACH VA
23462-4375
US

IV. Provider business mailing address

5041 CORPORATE WOODS DR SUITE 200
VIRGINIA BEACH VA
23462-4375
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-9323
  • Fax: 757-490-4519
Mailing address:
  • Phone: 757-490-9323
  • Fax: 757-490-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28176997A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172088
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: