Healthcare Provider Details

I. General information

NPI: 1447138128
Provider Name (Legal Business Name): GOULD KYLE ANGELO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 20TH ST STE 101
VERO BEACH FL
32966-1005
US

IV. Provider business mailing address

6480 20TH ST STE 101
VERO BEACH FL
32966-1005
US

V. Phone/Fax

Practice location:
  • Phone: 772-888-1790
  • Fax:
Mailing address:
  • Phone: 347-839-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11041819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: