Provider Demographics
NPI:1598420663
Name:PERUGINI, ANGELINA B
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:B
Last Name:PERUGINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 SW MOLLOY ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3549
Mailing Address - Country:US
Mailing Address - Phone:772-203-4355
Mailing Address - Fax:
Practice Address - Street 1:2143 SE ELMHURST RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4933
Practice Address - Country:US
Practice Address - Phone:772-207-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider