Individual
ANGELA EVONNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT/MMP
Contact information
Practice address
12336 SHADY SPRING WAY, ORLANDO, FL 32828-9172
(407) 427-6548
Mailing address
12336 SHADY SPRING WAY, ORLANDO, FL 32828-9172
(407) 427-6548
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA88337
FL
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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