Healthcare Provider Details

I. General information

NPI: 1790262863
Provider Name (Legal Business Name): ANGELIA DELANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELIA HENDERSON

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 CPL JOHNSON ROAD
APO AP
78234
US

IV. Provider business mailing address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

V. Phone/Fax

Practice location:
  • Phone: 406-381-1453
  • Fax:
Mailing address:
  • Phone: 850-881-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: