Provider Demographics
NPI:1487294781
Name:RECCA, ANGELA X (RN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:RECCA
Suffix:X
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 1:324 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2307
Mailing Address - Country:US
Mailing Address - Phone:347-342-6654
Mailing Address - Fax:
Practice Address - Street 1:324 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2307
Practice Address - Country:US
Practice Address - Phone:347-352-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY514499-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics