Provider Demographics
NPI:1134180433
Name:ANGIOLI, CAROLYN MARS (PNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARS
Last Name:ANGIOLI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DEBRA
Other - Last Name:MARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS CPNP
Mailing Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Mailing Address - Street 2:STE. H
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171
Mailing Address - Country:US
Mailing Address - Phone:703-860-4200
Mailing Address - Fax:703-860-1528
Practice Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Practice Address - Street 2:STE. H
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-860-4200
Practice Address - Fax:703-860-1528
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001234363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007788452Medicaid