Provider Demographics
NPI:1063651131
Name:DEANGELIS, NATHAN CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:4106 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3315
Mailing Address - Country:US
Mailing Address - Phone:407-833-9195
Mailing Address - Fax:407-833-9308
Practice Address - Street 1:4106 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3315
Practice Address - Country:US
Practice Address - Phone:407-833-9195
Practice Address - Fax:407-833-9308
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-051776208600000X
FLOS11555208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery