Provider Demographics
NPI:1861777567
Name:MEYERS, ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:710 N LEMON AVE UNIT 342
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4295
Mailing Address - Country:US
Mailing Address - Phone:702-468-9367
Mailing Address - Fax:
Practice Address - Street 1:5215 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5533
Practice Address - Country:US
Practice Address - Phone:941-907-3400
Practice Address - Fax:941-907-4202
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL08504082363AM0700X
FLPA9118352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0004389OtherSTATE LICENSE
IL085004082OtherSTATE LICENCE