| NPI | 1487921409 |
|---|---|
| Former Name | ANGELINA DAWN MCCORMACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 006317) |
| 363A00000X Physician Assistant (Licence: VA 0110005126) | |
| 363A00000X Physician Assistant (Licence: TX PA12050) | |
| 363A00000X Physician Assistant (Licence: CT 4254) | |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2022-11-21 |