Provider Demographics
NPI:1679355606
Name:MAITLAND, ANGIE P (APRN)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:P
Last Name:MAITLAND
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2940 S US HIGHWAY 1 STE C11
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8143
Mailing Address - Country:US
Mailing Address - Phone:772-466-6855
Mailing Address - Fax:772-464-6983
Practice Address - Street 1:2940 S US HIGHWAY 1 STE C11
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8143
Practice Address - Country:US
Practice Address - Phone:772-466-6855
Practice Address - Fax:772-464-6983
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015730363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology