Provider Demographics
NPI:1194291377
Name:LOEBENBERG, ANGELICA LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:LYNN
Last Name:LOEBENBERG
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 1:802 N BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2103
Mailing Address - Country:US
Mailing Address - Phone:727-447-3000
Mailing Address - Fax:727-210-4600
Practice Address - Street 1:802 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2103
Practice Address - Country:US
Practice Address - Phone:727-447-3000
Practice Address - Fax:727-210-4600
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9294173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner