Provider Demographics
NPI:1750698338
Name:BRAHAM, ANGEL (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:
Last Name:BRAHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-4805
Mailing Address - Country:US
Mailing Address - Phone:866-717-4555
Mailing Address - Fax:
Practice Address - Street 1:3903 MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-4805
Practice Address - Country:US
Practice Address - Phone:866-717-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5156727374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel