Individual
DR. ANGELA PREVATT BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10475 CENTURION PKWY N STE 302, JACKSONVILLE, FL 32256-5004
(904) 398-5437
(904) 398-3077
Mailing address
10475 CENTURION PKWY N STE 302, JACKSONVILLE, FL 32256-5004
(043) 985-4379
(043) 983-0779
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
ME115569
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
'009304000
—
FL
Enumeration date
06/12/2008
Last updated
07/01/2024
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