1881673531 NPI number — ANGELA D ANTONACCI-GIMBEL MD

Table of content: ANGELA D ANTONACCI-GIMBEL MD (NPI 1881673531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881673531 NPI number — ANGELA D ANTONACCI-GIMBEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTONACCI-GIMBEL
Provider First Name:
ANGELA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881673531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 TRAFALGAR CT.
Provider Second Line Business Mailing Address:
SUITE 200E
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-667-0444
Provider Business Mailing Address Fax Number:
407-667-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 HARRISON PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-831-2371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME92108 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64106 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271572400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108458100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".