Provider Demographics
NPI:1508219502
Name:MEISSNER, ANGELA KEMPTON (RN, RBT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KEMPTON
Last Name:MEISSNER
Suffix:
Gender:F
Credentials:RN, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 MONTEEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6676
Mailing Address - Country:US
Mailing Address - Phone:407-375-0330
Mailing Address - Fax:
Practice Address - Street 1:1530 S PRIMROSE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2587
Practice Address - Country:US
Practice Address - Phone:407-988-3510
Practice Address - Fax:407-988-3511
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB326140103K00000X
FLRN9165923163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015590800Medicaid
FL015731400Medicaid
FL1447619275Medicaid