Provider Demographics
NPI:1578044343
Name:SERRANO, ANGELICA (CNA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LONGVIEW AVE # 9206
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5095
Mailing Address - Country:US
Mailing Address - Phone:407-495-9170
Mailing Address - Fax:
Practice Address - Street 1:211 LONGVIEW AVE # 9206
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5095
Practice Address - Country:US
Practice Address - Phone:407-407-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8199604253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care