Provider Demographics
NPI:1346785987
Name:BLACKWOOD, ANGELLINE OPAL (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELLINE
Middle Name:OPAL
Last Name:BLACKWOOD
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 1:2585 S STATE ROAD 7
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9323
Mailing Address - Country:US
Mailing Address - Phone:561-795-8655
Mailing Address - Fax:561-795-8449
Practice Address - Street 1:2585 S STATE ROAD 7
Practice Address - Street 2:SUITE 110
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9323
Practice Address - Country:US
Practice Address - Phone:561-795-8655
Practice Address - Fax:561-795-8449
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner