Provider Demographics
NPI:1609896695
Name:LAI, ANGEL (PA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 NE 28TH AVE
Mailing Address - Street 2:UNIT 407
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-1236
Mailing Address - Country:US
Mailing Address - Phone:386-672-9992
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4004
Practice Address - Country:US
Practice Address - Phone:352-351-3407
Practice Address - Fax:352-351-7602
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
C18093Medicare UPIN