Provider Demographics
NPI:1841089695
Name:WHITTAMORE, ANGELA ROSE (PMHNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE
Last Name:WHITTAMORE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 FELLENZ ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-4785
Mailing Address - Country:US
Mailing Address - Phone:321-747-4331
Mailing Address - Fax:
Practice Address - Street 1:491 FELLENZ ST SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-4785
Practice Address - Country:US
Practice Address - Phone:321-747-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039263363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health