Provider Demographics
NPI:1962886705
Name:JOHN, ANGELLA M (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:M
Last Name:JOHN
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRWAY DR STE 305
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1802
Mailing Address - Country:US
Mailing Address - Phone:954-744-0020
Mailing Address - Fax:754-318-6211
Practice Address - Street 1:10 FAIRWAY DR STE 305
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1802
Practice Address - Country:US
Practice Address - Phone:954-744-0020
Practice Address - Fax:754-318-6211
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9212723207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9212723OtherSTATE LICENSE