Healthcare Provider Details

I. General information

NPI: 1992615041
Provider Name (Legal Business Name): ANGELICA GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 LAKE ARROWHEAD CIR
BEAR DE
19701-1796
US

IV. Provider business mailing address

209 LAKE ARROWHEAD CIR
BEAR DE
19701-1796
US

V. Phone/Fax

Practice location:
  • Phone: 302-358-5620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011212
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: