Provider Demographics
NPI:1629533674
Name:TRODGLEN, ANGELA RENEA (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEA
Last Name:TRODGLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 11TH LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3935
Mailing Address - Country:US
Mailing Address - Phone:772-643-8712
Mailing Address - Fax:
Practice Address - Street 1:1801 SE HILLMOOR DR STE C-207
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7574
Practice Address - Country:US
Practice Address - Phone:772-335-4234
Practice Address - Fax:772-335-4236
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner