Healthcare Provider Details

I. General information

NPI: 1790925261
Provider Name (Legal Business Name): ANGELA K COLEMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PARK PLACE BLVD
DAVENPORT FL
33837-6858
US

IV. Provider business mailing address

1613 HARRISON PKWY
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-2812
  • Fax:
Mailing address:
  • Phone: 954-838-2587
  • Fax: 954-858-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2806752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: