Provider Demographics
NPI:1760095103
Name:RENAUDIN, ANGENA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANGENA
Middle Name:
Last Name:RENAUDIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 CASON COVE DR APT 622
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6646
Mailing Address - Country:US
Mailing Address - Phone:407-668-1125
Mailing Address - Fax:
Practice Address - Street 1:4611 CASON COVE DR APT 622
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-6646
Practice Address - Country:US
Practice Address - Phone:407-668-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9471138163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management