Doctor Name: | MRS. ANGELA S ROBERTS |
NPI Number: | 1023077641 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 10000258A |
Business Practice Address: | 11 Riverside Dr Suite 200 Cocoa, FL - 329227840 |
Business Phone Number: | 3212217447 |
Business Fax Number: | 3212217448 |
Mailing Address: | 11 Riverside Dr, Suite 200 COCOA |
State: | FL |
Postal Code: | 329227840 |
Phone Number: | 3212217447 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 06/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 10000258A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |