Provider Demographics
NPI:1124144688
Name:BALDY, ANGELA RENAE (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENAE
Last Name:BALDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100A DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6708
Mailing Address - Country:US
Mailing Address - Phone:850-819-8477
Mailing Address - Fax:
Practice Address - Street 1:1714 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7299
Practice Address - Country:US
Practice Address - Phone:305-293-4233
Practice Address - Fax:305-293-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP30342022080P0006X, 363LP0200X, 363LP0808X
GARN229335363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTO BE ASSIGNEDMedicaid