Provider Demographics
NPI:1780304212
Name:POMILIO, ANGELA PATRICIA (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:PATRICIA
Last Name:POMILIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23249 ISLAND VW APT C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5662
Mailing Address - Country:US
Mailing Address - Phone:786-925-0134
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD STE 207
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7201
Practice Address - Country:US
Practice Address - Phone:561-430-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily