Provider Demographics
NPI:1639379357
Name:ULLON, ANGELA ADAMS (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ADAMS
Last Name:ULLON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5595 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:CA
Mailing Address - Zip Code:32571-5595
Mailing Address - Country:US
Mailing Address - Phone:850-981-7746
Mailing Address - Fax:
Practice Address - Street 1:5595 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-3257
Practice Address - Country:US
Practice Address - Phone:850-981-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19513363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAV161PMedicare PIN
CAAV161OMedicare PIN
CAAV161UMedicare PIN
CAAV161WMedicare PIN
CAAV161XMedicare PIN
CAAV161RMedicare PIN
CAAV161ZMedicare PIN
CAAV161SMedicare PIN
CAAV161VMedicare PIN
CAAV161YMedicare PIN
CAAV161TMedicare PIN
CAAV161NMedicare PIN