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NPI Code Detail

MEDICARE: ANGELA LONGACRE

MEDICARE: ANGELA LONGACRE
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
1106S00000XBehavior TechnicianRBT-24-341159FL

General Provider Information

NPI Number : 1053165746
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA LONGACRE
Provider Business Mailing Address
First Line : 1185 6TH ST
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-3625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 650 W NEW YORK AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-5239
Country : US
Telephone Number : 386-262-1907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2024
Last Update Date : 04/17/2024

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Directions to “ ANGELA LONGACRE ” Practice Location

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