Provider Demographics
NPI:1427683325
Name:VERDAGUEZ GONZALEZ, ANGEL (ARNP)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:VERDAGUEZ GONZALEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 NE 164TH ST APT 543
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4287
Mailing Address - Country:US
Mailing Address - Phone:786-923-7139
Mailing Address - Fax:
Practice Address - Street 1:2145 NE 164TH ST APT 543
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4287
Practice Address - Country:US
Practice Address - Phone:786-923-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner