Provider Demographics
NPI:1902115165
Name:STAKE, ANGELIQUE M (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:M
Last Name:STAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:
Practice Address - Street 1:3978 W HILLSBOROUGH AVE UNIT 21B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5628
Practice Address - Country:US
Practice Address - Phone:813-906-1412
Practice Address - Fax:813-413-1971
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214698363LP0200X
FLAPRN9214698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics