Provider Demographics
NPI:1326480344
Name:DEYONG, ANGELA KAYE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:DEYONG
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 1:36468 EMERALD COAST PKWY STE 7102
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-0712
Mailing Address - Country:US
Mailing Address - Phone:850-842-3256
Mailing Address - Fax:850-353-2561
Practice Address - Street 1:36468 EMERALD COAST PKWY STE 7102
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-0712
Practice Address - Country:US
Practice Address - Phone:850-842-3256
Practice Address - Fax:850-353-2561
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9300931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013431500Medicaid
FLY0P4QOtherBCBSFL
FL013431500Medicaid