Provider Demographics
NPI:1891132643
Name:ELLIOTT, ANGELA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJAX - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:653-1 W 8TH ST
Practice Address - Street 2:UFJAX - DEPT. OF OBGYN
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-6667
Practice Address - Fax:904-244-3124
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9202743367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134464AMedicaid
FL008955900Medicaid
GA003134464BMedicaid
GA003134464BMedicaid