Provider Demographics
NPI:1528314556
Name:ANDERSON, ANGELA TUCKER (MHA, FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:TUCKER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MHA, FNP-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEIGH
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:100 CONCOURSE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5751
Mailing Address - Country:US
Mailing Address - Phone:804-416-6673
Mailing Address - Fax:804-886-9046
Practice Address - Street 1:100 CONCOURSE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5751
Practice Address - Country:US
Practice Address - Phone:804-416-6673
Practice Address - Fax:804-886-9046
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily