Healthcare Provider Details

I. General information

NPI: 1093538118
Provider Name (Legal Business Name): ANGELA KIM PARK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 HIGHWAY 41 N
INVERNESS FL
34453-2454
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-480-0560
  • Fax: 352-480-0565
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: