Provider Demographics
NPI:1023824760
Name:SURACE, ANGELA M (DNP APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SURACE
Suffix:
Gender:F
Credentials:DNP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 STINSON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2950
Mailing Address - Country:US
Mailing Address - Phone:614-203-7775
Mailing Address - Fax:
Practice Address - Street 1:836 STINSON CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2950
Practice Address - Country:US
Practice Address - Phone:614-203-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03960363LS0200X
OH04028364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool