Provider Demographics
NPI:1912676636
Name:JEFFERSON, ANGELICA DENISE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:DENISE
Last Name:JEFFERSON
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 1:4509 SAGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5856
Mailing Address - Country:US
Mailing Address - Phone:205-585-7286
Mailing Address - Fax:
Practice Address - Street 1:4509 SAGEWOOD LN
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-5856
Practice Address - Country:US
Practice Address - Phone:205-585-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 225B00000X
M3B2H2C5246RP1900X
AL1074227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No174H00000XOther Service ProvidersHealth Educator
No225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function Technologist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy