Healthcare Provider Details

I. General information

NPI: 1780243311
Provider Name (Legal Business Name): ANGEL OAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 LARKIN RD
SPRING HILL FL
34608-6451
US

IV. Provider business mailing address

1591 LARKIN RD
SPRING HILL FL
34608-6451
US

V. Phone/Fax

Practice location:
  • Phone: 352-584-7473
  • Fax: 352-556-2612
Mailing address:
  • Phone: 352-584-7473
  • Fax: 352-556-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINE DE CIUTIIS
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 352-584-7473