Healthcare Provider Details

I. General information

NPI: 1639081706
Provider Name (Legal Business Name): ANGELINA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 E HWY 50 STE B
CLERMONT FL
34711-2779
US

IV. Provider business mailing address

977 VINERIDGE RUN APT 207
ALTAMONTE SPRINGS FL
32714-1775
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-4500
  • Fax:
Mailing address:
  • Phone: 954-614-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: