Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2850 | NC |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PY11215 | FL |
N | 103G00000X | Clinical Psychologist | 2850 | NC |
N | 103TC0700X | Clinical Psychologist | 2850 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2850 | NC |
NPI | 1144252545 |
---|---|
Provider Name | Dr. Angela Annette Priester |
First Address | Jacksonville, FL 32216-8200 |
Second Address | Jacksonville, FL 32216-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6000689 | (05) | NC |