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General NPI Number Information
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NPI Number | 1447370002
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Entity Type | Individual
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Provider Name | ANGELA NICOLE KING LMT
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 S PALM AVE
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City | PALATKA
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State | FL
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Zip | 32177-4140
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Country | US
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Telephone | 386-325-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 105 DELLWOOD AVE
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City | PALATKA
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State | FL
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Zip | 32177-6508
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Country | US
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Telephone | 386-312-8553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 32785
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License Number State | FL
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