Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 14695 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 14695 | TN |
NPI | 1023345352 |
---|---|
Provider Name | Mrs. Angelia D Winton |
First Address | Cleveland, TN 37311-3842 |
Second Address | Cleveland, TN 37311-3842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14695 | APN LICENSE (01) | TN |