Provider Demographics
NPI:1073367736
Name:COLE, ANGELA LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEIGH
Last Name:COLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEIGH
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2469 W HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3883
Mailing Address - Country:US
Mailing Address - Phone:810-407-6039
Mailing Address - Fax:
Practice Address - Street 1:2469 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3883
Practice Address - Country:US
Practice Address - Phone:810-407-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704357131363L00000X
MIF04240396207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner