Provider Demographics
NPI:1285776682
Name:MINTZ, ANGELA P (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:P
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5150 BAYOU BLVD
Practice Address - Street 2:STE 1N
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2158
Practice Address - Country:US
Practice Address - Phone:850-416-7656
Practice Address - Fax:850-416-7348
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00771932080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259332700Medicaid