Healthcare Provider Details

I. General information

NPI: 1760052302
Provider Name (Legal Business Name): A HEART OF AN ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7060 SCRUBOAK LN
ORLANDO FL
32818-5247
US

IV. Provider business mailing address

7060 SCRUBOAK LN
ORLANDO FL
32818-5247
US

V. Phone/Fax

Practice location:
  • Phone: 407-781-6866
  • Fax:
Mailing address:
  • Phone: 407-781-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATOSHA CATRICE HARRIS-IVY
Title or Position: MRG
Credential:
Phone: 140-778-1686