Individual
MRS. ANGELA MARIE BREWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2010 OCILLA RD, DOUGLAS, GA 31533-2230
(912) 384-2500
(912) 383-6788
Mailing address
1100 WARD STREET EXT W, DOUGLAS, GA 31533-1902
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN101667
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D0941435
CLIA ID
GA
01
—
385393
WELLCARE OF GEORGIA
GA
05
—
715148338A
—
GA
01
—
RN10167
GEORGIA LICENSE
GA
Enumeration date
05/16/2007
Last updated
07/02/2012
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