Provider Demographics
NPI:1376574962
Name:MORALES, ANGELA B (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:B
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BECKWITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:#1000
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5738
Mailing Address - Country:US
Mailing Address - Phone:239-624-8130
Mailing Address - Fax:239-624-8131
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:#1000
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5738
Practice Address - Country:US
Practice Address - Phone:239-624-8130
Practice Address - Fax:239-624-8131
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3478TOtherMEDICARE
FL291261900Medicaid
FLY05SLOtherBCBS
FLE3478XMedicare PIN
FLE3478TOtherMEDICARE