Provider Demographics
NPI:1659817930
Name:EYTCHISON, ANGELA (HIS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:EYTCHISON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MARELLA CT
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6838
Mailing Address - Country:US
Mailing Address - Phone:317-397-4212
Mailing Address - Fax:
Practice Address - Street 1:6024 N 9TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8281
Practice Address - Country:US
Practice Address - Phone:850-477-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5593237700000X
IN17001447A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist