MEDICARE: ANGEL KATELYN MINERVA

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	106S00000X	Behavior Technician	RBT-17-42286	FL
2	103K00000X	Behavior Analyst	1-21-53880	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	:	1245735455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL KATELYN MINERVA

Provider Business Mailing Address
First Line	:	16470 GLASSY LOCH LOOP
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34714-6608
Country	:	US
Telephone Number	:	321-289-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 HARTWOOD MARSH RD STE 7
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5390
Country	:	US
Telephone Number	:	407-720-5067
Fax Number	:

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

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	10/29/2025

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