MEDICARE: COLLEEN MARIE CANGIALOSI NP

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	363L00000X	Nurse Practitioner	11015866	FL

General Provider Information

NPI Number	:	1417619297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MARIE CANGIALOSI NP

Provider Business Mailing Address
First Line	:	11019 INSIDE LOOP
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11019 INSIDE LOOP
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8887
Country	:	US
Telephone Number	:	407-970-8414
Fax Number	:

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

Provider Enumeration Date	:	10/09/2021
Last Update Date	:	10/09/2021

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