1326470147 NPI number — MS. ANGELA LYNN HAINSWORTH M.S.

Table of content: MS. ANGELA LYNN HAINSWORTH M.S. (NPI 1326470147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326470147 NPI number — MS. ANGELA LYNN HAINSWORTH M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAINSWORTH
Provider First Name:
ANGELA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326470147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1849 DEAN RD
Provider Second Line Business Mailing Address:
SUITE #2402
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-4520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-674-8635
Provider Business Mailing Address Fax Number:
188-897-2540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1849 DEAN RD
Provider Second Line Business Practice Location Address:
SUITE #2402
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-674-8635
Provider Business Practice Location Address Fax Number:
188-897-2540
Provider Enumeration Date:
08/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH10995 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009868500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326470147 . This is a "NPI FOR ANGELA HAINSWORTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1578990784 . This is a "NPI FOR NORTH FLORIDA CENTER FOR COUNSELING, LLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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