Provider Demographics
NPI:1033447826
Name:ROSS, ANGELA MICHELLE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:IRVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:2030 OAK MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2575
Mailing Address - Country:US
Mailing Address - Phone:386-334-4082
Mailing Address - Fax:
Practice Address - Street 1:2030 OAK MEADOW CIR
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2575
Practice Address - Country:US
Practice Address - Phone:386-334-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA119110372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide