Healthcare Provider Details

I. General information

NPI: 1336331453
Provider Name (Legal Business Name): ANGELA COMBS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N. UNIVERSITY DRIVE S. 307
TAMARAC FL
33321
US

IV. Provider business mailing address

7421 N. UNIVERSITY DRIVE S. 307
TAMARAC FL
33321
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-7272
  • Fax:
Mailing address:
  • Phone: 954-720-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS10176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: