Provider Demographics
NPI:1205420155
Name:FREGEOLLE, ANGELA MARIE (MSN, APRN, NNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FREGEOLLE
Suffix:
Gender:F
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 SW 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2909
Mailing Address - Country:US
Mailing Address - Phone:305-205-9424
Mailing Address - Fax:
Practice Address - Street 1:10630 SW 146TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2909
Practice Address - Country:US
Practice Address - Phone:305-205-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011739363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal