Healthcare Provider Details

I. General information

NPI: 1730937004
Provider Name (Legal Business Name): ANGEL HANDS DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 SW IVORY RD
PORT ST LUCIE FL
34953-2142
US

IV. Provider business mailing address

2261 SW IVORY RD
PORT ST LUCIE FL
34953-2142
US

V. Phone/Fax

Practice location:
  • Phone: 772-418-9099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: SHARON COOPER
Title or Position: OWNER
Credential:
Phone: 772-207-6391