Provider Demographics
NPI:1851135990
Name:MIODOWSKI, AGATHA (MS)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:MIODOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7738 A C SKINNER PKWY APT 4204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8147
Mailing Address - Country:US
Mailing Address - Phone:224-402-4779
Mailing Address - Fax:
Practice Address - Street 1:1301 PALM AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8432
Practice Address - Country:US
Practice Address - Phone:844-632-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS