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NPI Code Detail

MEDICARE: ANGELA PARK DO

MEDICARE: ANGELA PARK DO
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
1207R00000XInternal Medicine PhysicianOS023299PA
2207R00000XInternal Medicine PhysicianR-11683IA
3207R00000XInternal Medicine PhysicianOS21142FL

General Provider Information

NPI Number : 1063073096
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA PARK DO
Provider Business Mailing Address
First Line : 3302 BONITA BEACH RD STE 170
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-4217
Country : US
Telephone Number : 239-624-1050
Fax Number :
Provider Business Practice Location Address
First Line : 3302 BONITA BEACH RD STE 170
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-4217
Country : US
Telephone Number : 239-624-1050
Fax Number : 239-624-1051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2019
Last Update Date : 08/21/2024

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Directions to “ ANGELA PARK DO” Practice Location

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