MEDICARE: ANGELA DENISE ALLEN

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	372600000X	Adult Companion
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker
4	376K00000X	Nurse's Aide	CNA207854	FL

General Provider Information

NPI Number	:	1386044261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DENISE ALLEN

Provider Business Mailing Address
First Line	:	16605 MANDY LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1012
Country	:	US
Telephone Number	:	386-269-2290
Fax Number	:

Provider Business Practice Location Address
First Line	:	16605 MANDY LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1012
Country	:	US
Telephone Number	:	386-269-2290
Fax Number	:

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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Directions to “ ANGELA DENISE ALLEN ” Practice Location

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