Provider Demographics
NPI:1164130373
Name:CENTENO, ANGELYS JACKELINE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELYS
Middle Name:JACKELINE
Last Name:CENTENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANGELYS
Other - Middle Name:
Other - Last Name:CENTENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18921 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5829
Mailing Address - Country:US
Mailing Address - Phone:305-494-7433
Mailing Address - Fax:
Practice Address - Street 1:18921 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5829
Practice Address - Country:US
Practice Address - Phone:305-494-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9571083163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty