=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457878654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELA WHITE ARNP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2017
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 LOS PALMAS DR
-----------------------------------------------------
City | FLEMING ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-544-3608
-----------------------------------------------------
Fax | 904-263-5381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000-18 HWY 17 #44
-----------------------------------------------------
City | FLEMING ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANGELA D WHITE
-----------------------------------------------------
Credential | ARNP PHD
-----------------------------------------------------
Telephone | 904-544-3608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 3298772
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------