Provider Demographics
NPI:1669561650
Name:CALLAHAN, ANGELITA M
Entity type:Individual
Prefix:
First Name:ANGELITA
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELITA
Other - Middle Name:M
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4251
Mailing Address - Country:US
Mailing Address - Phone:352-333-6680
Mailing Address - Fax:352-331-4006
Practice Address - Street 1:23343 NW COUNTY ROAD 236
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-9669
Practice Address - Country:US
Practice Address - Phone:386-454-0698
Practice Address - Fax:386-454-0690
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118447207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN