Provider Demographics
NPI:1699404830
Name:ROSS, ANGELINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:ELIZABETH
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 BLUE CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8111
Mailing Address - Country:US
Mailing Address - Phone:908-217-8440
Mailing Address - Fax:
Practice Address - Street 1:591 BLUE CYPRESS DR
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8111
Practice Address - Country:US
Practice Address - Phone:908-217-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL236Medicaid
FL568946544OtherBCBA
5874OtherHEALTH PARTNERS