MEDICARE: ANGEL ANTHONY RODELA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN.1657562	CO

General Provider Information

NPI Number	:	1366380404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL ANTHONY RODELA FNP-C

Provider Business Mailing Address
First Line	:	15962 LITTLE BLUESTEM RD
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7513
Country	:	US
Telephone Number	:	779-456-0524
Fax Number	:

Provider Business Practice Location Address
First Line	:	15962 LITTLE BLUESTEM RD
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7513
Country	:	US
Telephone Number	:	779-456-0524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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