Provider Demographics
NPI:1629655436
Name:KNOTT, MARY ANGELA (CNA)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANGELA
Last Name:KNOTT
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 1:184 PINENEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-4624
Mailing Address - Country:US
Mailing Address - Phone:206-280-4695
Mailing Address - Fax:
Practice Address - Street 1:184 PINENEEDLE DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-4624
Practice Address - Country:US
Practice Address - Phone:206-280-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000237846253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care