Provider Demographics
NPI:1346616588
Name:BAUER, ANGELA SHAAK
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHAAK
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 NW 143RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-3408
Mailing Address - Country:US
Mailing Address - Phone:352-262-6022
Mailing Address - Fax:352-333-3151
Practice Address - Street 1:4415 NW 143RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3408
Practice Address - Country:US
Practice Address - Phone:352-262-6022
Practice Address - Fax:352-333-3151
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator