Provider Demographics
NPI:1417122003
Name:SLOAN, ANGEL R
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:SLOAN
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 1:2689 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-6549
Mailing Address - Country:US
Mailing Address - Phone:863-709-0044
Mailing Address - Fax:863-709-0044
Practice Address - Street 1:2689 SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-6549
Practice Address - Country:US
Practice Address - Phone:863-709-0044
Practice Address - Fax:863-709-0044
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230004400Medicaid