Healthcare Provider Details

I. General information

NPI: 1124942057
Provider Name (Legal Business Name): ALYSSA WESTMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 LAKE GRAY BLVD STE 108
JACKSONVILLE FL
32244-5867
US

IV. Provider business mailing address

3737 SAINT JOHNS BLUFF RD S
JACKSONVILLE FL
32224-2652
US

V. Phone/Fax

Practice location:
  • Phone: 904-412-8542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1614681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: