Provider Demographics
NPI:1174205058
Name:JOSEPH, ANGELLA YAMILEH
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:YAMILEH
Last Name:JOSEPH
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 1:9331 STANMOOR LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7154
Mailing Address - Country:US
Mailing Address - Phone:904-370-9756
Mailing Address - Fax:
Practice Address - Street 1:76011 WILLIAM BURGESS BLVD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5428
Practice Address - Country:US
Practice Address - Phone:904-427-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily