Provider Demographics
NPI:1548725864
Name:HILL, ANGELA D
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AEROSPACE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3910
Mailing Address - Country:US
Mailing Address - Phone:386-226-7917
Mailing Address - Fax:386-226-6082
Practice Address - Street 1:1 AEROSPACE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3910
Practice Address - Country:US
Practice Address - Phone:386-226-7917
Practice Address - Fax:386-226-6082
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9379217163WP0807X
FLAPRN11037091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent