Provider Demographics
NPI:1689494197
Name:ANGALL-LEONCE, MARCELLE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:ANGALL-LEONCE
Suffix:
Gender:F
Credentials:DNP, 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 1:560 BAY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6622
Mailing Address - Country:US
Mailing Address - Phone:321-229-2889
Mailing Address - Fax:
Practice Address - Street 1:560 BAY GROVE RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6622
Practice Address - Country:US
Practice Address - Phone:321-229-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
GARN243143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach