Individual
ANGELA BROADNAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
505 MATECUMBE CT, MACCLENNY, FL 32063-8832
(904) 327-1135
Mailing address
505 MATECUMBE CT, MACCLENNY, FL 32063-8832
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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