Healthcare Provider Details

I. General information

NPI: 1265057798
Provider Name (Legal Business Name): ANGELIKA MARIE AGUDELO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SE 18TH AVE STE 300
OCALA FL
34471-8214
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-1313
  • Fax:
Mailing address:
  • Phone: 352-205-8981
  • Fax: 352-391-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05200259
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN111010838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: