Provider Demographics
NPI:1508500398
Name:MCLOUGHLIN, ANGELIQUE CAROLINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:CAROLINE
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:136 JULIA ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7713
Mailing Address - Country:US
Mailing Address - Phone:386-423-9161
Mailing Address - Fax:386-423-3094
Practice Address - Street 1:136 JULIA ST UNIT 100
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7713
Practice Address - Country:US
Practice Address - Phone:386-423-9161
Practice Address - Fax:386-423-3094
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9467528363LP0808X
FLAPRN11022271363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health