MEDICARE: ANGELA MARIE WARREN 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	28176997A	IN
2	363LF0000X	Family Nurse Practitioner	0024172088	VA

General Provider Information

NPI Number	:	1629418439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE WARREN FNP-C

Provider Business Mailing Address
First Line	:	5041 CORPORATE WOODS DR
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4375
Country	:	US
Telephone Number	:	757-490-9323
Fax Number	:	757-490-4519

Provider Business Practice Location Address
First Line	:	5041 CORPORATE WOODS DR
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4375
Country	:	US
Telephone Number	:	757-490-9323
Fax Number	:	757-490-4519

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	11/08/2024

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