Provider Demographics
NPI:1154069151
Name:CARDELLO, ANGELICA NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:NICOLE
Last Name:CARDELLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 MARLINSPIKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5857
Mailing Address - Country:US
Mailing Address - Phone:816-809-8944
Mailing Address - Fax:
Practice Address - Street 1:3476 MARLINSPIKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5857
Practice Address - Country:US
Practice Address - Phone:816-809-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty