Healthcare Provider Details

I. General information

NPI: 1053237446
Provider Name (Legal Business Name): ANGEL MCDUFFIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11786 SHIRBURN CIR
PARRISH FL
34219-7507
US

IV. Provider business mailing address

11786 SHIRBURN CIR
PARRISH FL
34219-7507
US

V. Phone/Fax

Practice location:
  • Phone: 813-570-0094
  • Fax:
Mailing address:
  • Phone: 813-570-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number241897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: