Healthcare Provider Details

I. General information

NPI: 1356096010
Provider Name (Legal Business Name): ANGELA MARGARET PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3616
US

IV. Provider business mailing address

2301 MAITLAND CENTER PKWY STE 240
MAITLAND FL
32751-7415
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-4617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-22-198753
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-198753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: