Provider Demographics
NPI:1780256685
Name:VELASCO, ANGELA L (MSN, APRN, A-GNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MSN, APRN, A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 PIEDMONT LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5938
Mailing Address - Country:US
Mailing Address - Phone:407-780-9083
Mailing Address - Fax:
Practice Address - Street 1:2009 PIEDMONT LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5938
Practice Address - Country:US
Practice Address - Phone:407-780-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health