Healthcare Provider Details

I. General information

NPI: 1750480505
Provider Name (Legal Business Name): ANGELA L DENMARK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

4221 SW 282ND ST
NEWBERRY FL
32669-4328
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-376-9482
Mailing address:
  • Phone: 352-376-1611
  • Fax: 352-376-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3299482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: