Provider Demographics
NPI:1689894149
Name:ANGELL, JENNIFER E (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:ANGELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2840
Mailing Address - Country:US
Mailing Address - Phone:772-571-6926
Mailing Address - Fax:
Practice Address - Street 1:1060 WOODCOCK RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3502
Practice Address - Country:US
Practice Address - Phone:813-575-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9313055363LA2100X, 363LA2100X
FL9356404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9313055OtherFL LICENSE
FL9313055OtherFL LICENSE
RIRI37377OtherRI LICENSE