Healthcare Provider Details

I. General information

NPI: 1104491935
Provider Name (Legal Business Name): ANGELINE FLEURIMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 JACKFRUIT CT
RIVERVIEW FL
33578-3321
US

IV. Provider business mailing address

9911 JACKFRUIT CT
RIVERVIEW FL
33578-3321
US

V. Phone/Fax

Practice location:
  • Phone: 561-628-4477
  • Fax:
Mailing address:
  • Phone: 561-628-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11330
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001084
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006426
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1112075
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: