Healthcare Provider Details

I. General information

NPI: 1558240572
Provider Name (Legal Business Name): ANGELINA VLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 520
HOLLYWOOD FL
33021-5431
US

IV. Provider business mailing address

2900 CORPORATE WAY # D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3500
  • Fax: 954-985-4230
Mailing address:
  • Phone: 786-608-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11042004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: