Provider Demographics
NPI:1114808151
Name:NELSON, ANGIE M
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MALIBU BAY DR APT 207
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8401
Mailing Address - Country:US
Mailing Address - Phone:561-324-5887
Mailing Address - Fax:
Practice Address - Street 1:740 MALIBU BAY DR APT 207
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33401-8401
Practice Address - Country:US
Practice Address - Phone:561-324-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44771167246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy