Provider Demographics
NPI:1518201300
Name:JONES, ANGELIQUE MAUREEN (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:MAUREEN
Last Name:JONES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:12311 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2673
Practice Address - Country:US
Practice Address - Phone:904-674-2699
Practice Address - Fax:904-674-6710
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9202690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0073691-00Medicaid
FL0073691-00Medicaid
FLP01229958Medicare PIN