Healthcare Provider Details

I. General information

NPI: 1861492498
Provider Name (Legal Business Name): ANGELA Y ROSS-JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3854 BRITTON PLZ
TAMPA FL
33611-1406
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 813-837-2814
  • Fax: 813-839-4336
Mailing address:
  • Phone: 305-500-2027
  • Fax: 305-500-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number13200
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME99356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: