Healthcare Provider Details

I. General information

NPI: 1205415940
Provider Name (Legal Business Name): AYANA CRAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

IV. Provider business mailing address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax: 954-982-6491
Mailing address:
  • Phone: 888-754-0398
  • Fax: 954-982-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: