Provider Demographics
NPI:1467704429
Name:BOULWARE, ANGEL BROWN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:BROWN
Last Name:BOULWARE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 WYNTERSET DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8631
Mailing Address - Country:US
Mailing Address - Phone:404-388-3421
Mailing Address - Fax:
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7769
Practice Address - Country:US
Practice Address - Phone:678-582-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172317363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner