Healthcare Provider Details

I. General information

NPI: 1497659981
Provider Name (Legal Business Name): ANGELINE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12421 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-8659
US

IV. Provider business mailing address

PO BOX 10827
TALLAHASSEE FL
32302-2827
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-8430
  • Fax:
Mailing address:
  • Phone: 850-521-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number262856411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: