Provider Demographics
NPI:1053797399
Name:MARSHALL, ANGELA LEE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSN, FNP-C
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Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:828-232-1955
Mailing Address - Fax:828-232-0329
Practice Address - Street 1:1350 CONCOURSE AVE STE 363
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2023
Practice Address - Country:US
Practice Address - Phone:901-260-6161
Practice Address - Fax:901-260-6162
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27470363L00000X, 363L00000X
NC5007833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN27470OtherSTATE OF TN
TNT16822BOtherPALMETTO GBA
NCNCP908DOtherMEDICARE PTAN
NCNCP908EOtherMEDICARE PTAN