Healthcare Provider Details

I. General information

NPI: 1366543456
Provider Name (Legal Business Name): ANGEL A NUNEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E REDSTONE AVE
CRESTVIEW FL
32539-5348
US

IV. Provider business mailing address

1005 MAR WALT DRIVE
FORT WALTON BEACH FL
32547
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-8725
  • Fax: 850-398-8727
Mailing address:
  • Phone: 850-243-0118
  • Fax: 850-243-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME80005
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME80005
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME80005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: