Provider Demographics
NPI:1497955546
Name:TAYLOR, ANGELA EVETTE (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:EVETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34143-0081
Mailing Address - Country:US
Mailing Address - Phone:239-657-6498
Mailing Address - Fax:
Practice Address - Street 1:865 91ST AVENUE NORTH
Practice Address - Street 2:MORNING STAR HOME HEALTH CARE
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2426
Practice Address - Country:US
Practice Address - Phone:239-597-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN-1213291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse