Provider Demographics
NPI:1699416453
Name:MESA, ANGGIE JANNESSA (MD)
Entity type:Individual
Prefix:
First Name:ANGGIE
Middle Name:JANNESSA
Last Name:MESA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 18TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6481
Mailing Address - Country:US
Mailing Address - Phone:772-925-8190
Mailing Address - Fax:772-925-8199
Practice Address - Street 1:981 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6541
Practice Address - Country:US
Practice Address - Phone:772-257-5785
Practice Address - Fax:772-257-5325
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172479208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program