Provider Demographics
NPI:1811240518
Name:HALL, ANGELA KAKALEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAKALEY
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:KAKALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3821 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 CARIBBEAN WAY RM 137
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2028
Practice Address - Country:US
Practice Address - Phone:305-982-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004576363A00000X
FLPA9106417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant