Provider Demographics
NPI:1679168678
Name:HART, ANGELA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 EXETER RD STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1985
Mailing Address - Country:US
Mailing Address - Phone:731-265-6197
Mailing Address - Fax:
Practice Address - Street 1:54 EXETER RD STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1985
Practice Address - Country:US
Practice Address - Phone:731-265-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily