MEDICARE: MS. ANGEL LEN HERNDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC2100X	Continence Care Registered Nurse	9575091	FL
2	163WW0000X	Wound Care Registered Nurse	9575091	FL
3	163WX1500X	Ostomy Care Registered Nurse	9575091	FL

General Provider Information

NPI Number	:	1023969680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGEL LEN HERNDON

Provider Business Mailing Address
First Line	:	709 MACON DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 MACON DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4919
Country	:	US
Telephone Number	:	601-819-0405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/23/2026

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