Provider Demographics
NPI:1881622660
Name:NEALE, ANGELA M (PA)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:NEALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-724-8611
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:6633 FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-724-8611
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109686363AM0700X
GA004511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019190600Medicaid
GA970375307AMedicaid
GA970375307DMedicaid
FL019190600Medicaid
FL019190600Medicaid
GA970375307EMedicaid
GA970375307DMedicaid
FLIU334ZMedicare PIN