Provider Demographics
NPI:1730514167
Name:GAY, ANGELINA CLARISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:CLARISE
Last Name:GAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FOXFIRE RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5740
Mailing Address - Country:US
Mailing Address - Phone:423-284-0099
Mailing Address - Fax:
Practice Address - Street 1:2011 FOXFIRE RD NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-5740
Practice Address - Country:US
Practice Address - Phone:423-284-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000061115374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician