MEDICARE: ANGELA RENEE NEARN

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		VA

General Provider Information

NPI Number	:	1932861507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA RENEE NEARN

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-244-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	44933 GEORGE WASHINGTON BLVD STE 110
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-6301
Country	:	US
Telephone Number	:	571-520-4763
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	06/15/2026

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