Individual
ANGELO AMBRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3636 HIGH ST, PORTSMOUTH, VA 23707-3236
(757) 398-2200
Mailing address
1925 GRAND BAY DR, VIRGINIA BEACH, VA 23456-6378
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024179837
VA
367500000X
Certified Registered Nurse Anesthetist
0024179837
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
128421
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1258
—
VA
Enumeration date
06/10/2020
Last updated
05/15/2022
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