Healthcare Provider Details

I. General information

NPI: 1790242295
Provider Name (Legal Business Name): ANGELA RENEE LAWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 BAY HILL DR
GRAND ISLAND FL
32735-8487
US

IV. Provider business mailing address

12631 BAY HILL DR
GRAND ISLAND FL
32735-8487
US

V. Phone/Fax

Practice location:
  • Phone: 803-522-8930
  • Fax:
Mailing address:
  • Phone: 803-522-8930
  • Fax: 803-522-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: