Provider Demographics
NPI:1144252545
Name:PRIESTER, ANGELA ANNETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ANNETTE
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ANNETTE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 2402
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8200
Mailing Address - Country:US
Mailing Address - Phone:904-399-0324
Mailing Address - Fax:904-944-4379
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 2402
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8200
Practice Address - Country:US
Practice Address - Phone:904-399-0324
Practice Address - Fax:904-944-4379
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2850103TB0200X, 103TC0700X, 103TC2200X
FLPY11215103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000689Medicaid
NC2822334AMedicare ID - Type Unspecified