Healthcare Provider Details

I. General information

NPI: 1205224821
Provider Name (Legal Business Name): ANGELA VASCONCELOS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14943 SW 88TH TER
MIAMI FL
33196-1429
US

IV. Provider business mailing address

14943 SW 88TH TER
MIAMI FL
33196-1429
US

V. Phone/Fax

Practice location:
  • Phone: 786-273-8423
  • Fax:
Mailing address:
  • Phone: 786-273-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number698775453
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number223064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: