Provider Demographics
NPI:1518918382
Name:VENEZIA, ANGELA DENISE (DNP, APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:DENISE
Other - Last Name:TYYKILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:801 WEST OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-846-3455
Mailing Address - Fax:407-846-3670
Practice Address - Street 1:801 WEST OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-846-3455
Practice Address - Fax:407-846-3670
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9176614363LP0200X
FLARNP9176614363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021632600Medicaid
500018342OtherRAILROAD MEDICARE
FLY0106OtherBCBS
500018342OtherRAILROAD MEDICARE
500018342OtherRAILROAD MEDICARE