Healthcare Provider Details

I. General information

NPI: 1558282079
Provider Name (Legal Business Name): ANGELINE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10449 GENTLE RAIN DR
LAND O' LAKES FL
34638
US

IV. Provider business mailing address

15985 PRESERVE MARKETPLACE BLVD # 1114
ODESSA FL
33556-5509
US

V. Phone/Fax

Practice location:
  • Phone: 727-992-0184
  • Fax:
Mailing address:
  • Phone: 727-992-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK LLOYD NIELSEN II
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: DNP, APRN, FNP-BC
Phone: 727-992-0184