Provider Demographics
NPI:1396061123
Name:JONES, ANGELA MARIE (MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 NW 124TH TER APT 303
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5245
Mailing Address - Country:US
Mailing Address - Phone:954-529-1167
Mailing Address - Fax:
Practice Address - Street 1:10044 NW 1ST CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7005
Practice Address - Country:US
Practice Address - Phone:954-741-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2967363A00000X
363A00000X
FLPA9105244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396061123Medicaid
WI1396061123Medicaid