Basic Information
| Provider Information | |||||||||
| NPI: | 1912528845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGELOS | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 COCONUT DR | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349493439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725790138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2020 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.