Black, Angela Prevatt
Black, Angela Prevatt is an individual health care provider with primary practice located at 10475 Centurion Pkwy N Ste 302 , Jacksonville FL 32256-5004. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Otolaryngology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Pediatric Otolaryngology is her primary health care specialty. Black, Angela Prevatt can be contacted via phone (904) 398-5437.Contact Information
Primary practice address
10475 Centurion Pkwy N Ste 302
Jacksonville FL 32256-5004
Phone: (904) 398-5437
Fax: (904) 398-3077
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Otolaryngology | 207YP0228X | ME115569 | Florida |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X |
Profile Details
| NPI number | 1275793358 |
|---|---|
| LBN Legal business name | Black, Angela Prevatt |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2008 |
| Last updated | Jul 1st, 2024 - about 5 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275793358 | NPPES |
| Florida | MEDICAID | '009304000 |
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