Healthcare Provider Details

I. General information

NPI: 1427902006
Provider Name (Legal Business Name): MAKA MCLOUGHLIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32124-1026
US

IV. Provider business mailing address

3500 W INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32124-1026
US

V. Phone/Fax

Practice location:
  • Phone: 407-906-3755
  • Fax: 386-271-2861
Mailing address:
  • Phone: 407-906-3755
  • Fax: 386-271-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIQUE CAROLINE MCLOUGHLIN
Title or Position: PMHNP-BC
Credential: APRN
Phone: 407-906-3755