Healthcare Provider Details

I. General information

NPI: 1659374106
Provider Name (Legal Business Name): ANGELA DAWN LOVE CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 43RD AVE SW
VERO BEACH FL
32968-2382
US

IV. Provider business mailing address

126 43RD AVE SW
VERO BEACH FL
32968-2382
US

V. Phone/Fax

Practice location:
  • Phone: 772-766-5683
  • Fax: 772-539-8369
Mailing address:
  • Phone: 772-766-5683
  • Fax: 772-539-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 3390252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: