Provider Demographics
NPI:1730937160
Name:TERRELL, ANGELICA ELIZABETH (DC)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:ELIZABETH
Last Name:TERRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 EVAN SAMUEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-0403
Mailing Address - Country:US
Mailing Address - Phone:904-535-3010
Mailing Address - Fax:
Practice Address - Street 1:13305 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2844
Practice Address - Country:US
Practice Address - Phone:850-234-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor