Angela Broadnax
Individual provider Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Macclenny, FL
NPI 1457089682 · NPPES record last updated Aug 15, 2022
Key facts
- NPI
- 1457089682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Practice address
- 505 Matecumbe CT
Macclenny, FL 32063-8832 - Phone
- (904) 327-1135
- NPI assigned
- Aug 15, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greater Purpose Missions Inc | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
505 Matecumbe CT
Macclenny, FL 32063-8832
Mailing address
505 Matecumbe CT
Macclenny, FL 32063-8832
Other providers in Macclenny, FL
- Amanda Jean Bondie
- Janie Boulware
- Tiffany Faye Braddy
- Johnnie N Bradley-Goodman
- Brittany N Day, DDS, PA
- Jennifer K Brown
- Robert Brown
- Scott Cales
- Shirley Aida Campbell
- Ashley Nichelle Canaday
All providers in Macclenny, FL · Mental Health Clinic/Center (Including Community Mental Health Center) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.