MEDICARE: ANGELA LEAH OVERTURF FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP7466	AZ

General Provider Information

NPI Number	:	1457758609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LEAH OVERTURF FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 746093
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6093
Country	:	US
Telephone Number	:	773-352-1517
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	2720 SOUTH 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-4701
Country	:	US
Telephone Number	:	520-475-5418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	03/25/2024

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