Provider Demographics
NPI:1023509577
Name:KALLEN, ANGELIA (RN)
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:KALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12927 HIGHLAND GATE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1663
Mailing Address - Country:US
Mailing Address - Phone:386-846-3551
Mailing Address - Fax:
Practice Address - Street 1:12927 HIGHLAND GATE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1663
Practice Address - Country:US
Practice Address - Phone:386-846-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9182019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty