Angelic Primary Medicine of SC, LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

ANGELIC PRIMARY MEDICINE OF SC, LLC

Practice address

4728 Jenn Dr Ste 102
Myrtle Beach, SC 29577-5714

Phone

(609) 464-1135

Fax

(609) 822-7980

NPI assigned

Jul 23, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janet Gibson, APNNPI 1043601156

Title

Owner

Phone

(609) 464-1135

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Janet Gibson

  • Family Nurse Practitioner
  • Pleasantville, NJ
  • NPI 1043601156

  SC

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1730752015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8025 BLACK HORSE PIKE STE 501",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082322967",
            "telephone_number": "609-822-7979",
            "fax_number": "609-822-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4728 JENN DR STE 102",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775714",
            "telephone_number": "609-464-1135",
            "fax_number": "609-822-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELIC PRIMARY MEDICINE OF SC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-464-1135",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "24726",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angel Oak Nursing and Rehabilitation Center LLC
• Angelic Health of SC LLC
• Angelic Health of SC LLC
• Angelic Health Practice Group
• Angelic Health Practice Group
• Michelle Angelo, DPT
• Angels From Heaven LLC
• Illyana Marie Annunziato, MA, LPC, BC-TMH, NCC
• Emily Nichole Ansel, LISW-CP
• Milica Antic, M.D.

• All providers in Myrtle Beach, SC
• Primary Care Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.