Provider Demographics
NPI:1225445448
Name:JOHNSON, ANGELA R (AUD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:AMBROSIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 41516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1516
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-391-5836
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5472
Practice Address - Country:US
Practice Address - Phone:904-202-6410
Practice Address - Fax:904-390-7382
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1876231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHV718ZMedicare PIN