MEDICARE: ANGELICA NORMAN APRN

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	363LF0000X	Family Nurse Practitioner	11007621	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124636089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA NORMAN APRN

Provider Business Mailing Address
First Line	:	2884 SE PACE DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-6219
Country	:	US
Telephone Number	:	772-607-1813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1822 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5545
Country	:	US
Telephone Number	:	772-337-2001
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “ ANGELICA NORMAN APRN” Practice Location

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