Healthcare Provider Details

I. General information

NPI: 1598222002
Provider Name (Legal Business Name): ANGELA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 AMARAL ST STE 100
RIVERSIDE RI
02915-2205
US

IV. Provider business mailing address

1 PARK ROW W APT 214
PROVIDENCE RI
02903-1931
US

V. Phone/Fax

Practice location:
  • Phone: 352-275-2064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11017911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2360551
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9266263
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN04738
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: