Provider Demographics
NPI:1063405553
Name:SULLIVAN-BOWMAN, ANGELA H (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:H
Last Name:SULLIVAN-BOWMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 EAST OAKLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1843
Mailing Address - Country:US
Mailing Address - Phone:423-926-2358
Mailing Address - Fax:423-926-2680
Practice Address - Street 1:2403 BATTLEFIELD PARKWAY
Practice Address - Street 2:
Practice Address - City:FT. OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742
Practice Address - Country:US
Practice Address - Phone:706-866-7700
Practice Address - Fax:423-476-4487
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6046363LF0000X
GAGAA-NP000772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641138Medicare ID - Type Unspecified
TNQ01619Medicare UPIN