Provider Demographics
NPI:1043971864
Name:NAGASSAR, ANGELINA (DOM)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:
Last Name:NAGASSAR
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 FOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3053
Mailing Address - Country:US
Mailing Address - Phone:407-223-5075
Mailing Address - Fax:
Practice Address - Street 1:1617 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4809
Practice Address - Country:US
Practice Address - Phone:407-223-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist