MEDICARE: BRENDA SUE DEANGELIS BOYD

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	71009189A	IN
2	363LG0600X	Gerontology Nurse Practitioner	71009189A	IN

General Provider Information

NPI Number	:	1497309942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA SUE DEANGELIS BOYD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	844-630-0700
Fax Number	:	877-374-1924

Provider Business Practice Location Address
First Line	:	2902 W 86TH ST STE 220
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2196
Country	:	US
Telephone Number	:	317-343-8607
Fax Number	:	877-473-0054

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

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	10/23/2025

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Directions to “ BRENDA SUE DEANGELIS BOYD ” Practice Location

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