Provider Demographics
NPI:1215535588
Name:FEITO MADRIGAL, ANGEL O (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:O
Last Name:FEITO MADRIGAL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 W ABDELLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1603
Mailing Address - Country:US
Mailing Address - Phone:813-400-2201
Mailing Address - Fax:813-212-5230
Practice Address - Street 1:4311 W WATERS AVE STE 304B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1901
Practice Address - Country:US
Practice Address - Phone:813-400-2201
Practice Address - Fax:813-212-5230
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008497363L00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11008497Medicaid