Provider Demographics
NPI:1225608524
Name:ANKROM, ANGELA A
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:A
Last Name:ANKROM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:A
Other - Last Name:DZUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-273-8555
Mailing Address - Fax:352-294-8088
Practice Address - Street 1:1701 SW 16TH AVE BLDG B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1153
Practice Address - Country:US
Practice Address - Phone:352-273-8555
Practice Address - Fax:352-294-8088
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator