Provider Demographics
NPI:1790262863
Name:DELANO, ANGELIA
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:DELANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 LIELMANIS AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5613
Mailing Address - Country:US
Mailing Address - Phone:850-881-2015
Mailing Address - Fax:
Practice Address - Street 1:3222 CPL JOHNSON ROAD
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:406-381-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians