Provider Demographics
NPI:1962251231
Name:WILSON, ANGELA FELICIA (LPN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:FELICIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2145
Mailing Address - Country:US
Mailing Address - Phone:954-534-5298
Mailing Address - Fax:954-973-4391
Practice Address - Street 1:2860 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2145
Practice Address - Country:US
Practice Address - Phone:954-534-5298
Practice Address - Fax:954-973-4391
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5258862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse