Healthcare Provider Details

I. General information

NPI: 1689826489
Provider Name (Legal Business Name): MRS. MARIA FERNANDA ANGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 FLORIDA AVE S SUITE A
ROCKLEDGE FL
32955-2152
US

IV. Provider business mailing address

1767 AUBURN LAKES DR
VIERA FL
32955-6784
US

V. Phone/Fax

Practice location:
  • Phone: 321-634-3688
  • Fax: 321-504-0955
Mailing address:
  • Phone: 321-634-3688
  • Fax: 321-504-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: