Healthcare Provider Details

I. General information

NPI: 1699416453
Provider Name (Legal Business Name): ANGGIE JANNESSA MESA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 37TH PL
VERO BEACH FL
32960-6541
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-5785
  • Fax: 772-257-5325
Mailing address:
  • Phone: 772-925-8190
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME172479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: