Provider Demographics
NPI:1174613962
Name:NORMAN, ANGELA (FNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 W OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4586
Mailing Address - Country:US
Mailing Address - Phone:870-863-2000
Mailing Address - Fax:870-863-5442
Practice Address - Street 1:403 W OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4586
Practice Address - Country:US
Practice Address - Phone:870-863-2000
Practice Address - Fax:870-863-5442
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
5U962Medicare ID - Type Unspecified
P15510Medicare UPIN