Healthcare Provider Details

I. General information

NPI: 1679773568
Provider Name (Legal Business Name): ANGELA FICKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 FOXFIRE LN APT 105
NAPLES FL
34104-4941
US

IV. Provider business mailing address

1025 FOXFIRE LN APT 105
NAPLES FL
34104-4941
US

V. Phone/Fax

Practice location:
  • Phone: 239-776-5960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number19995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: