Provider Demographics
NPI:1235600321
Name:MCDONALD, ANGELA JUSTINA
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JUSTINA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 MIKRIS DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7607
Mailing Address - Country:US
Mailing Address - Phone:904-554-9913
Mailing Address - Fax:904-329-2952
Practice Address - Street 1:3047 MIKRIS DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7607
Practice Address - Country:US
Practice Address - Phone:904-554-9913
Practice Address - Fax:904-329-2952
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018999600Medicaid