Healthcare Provider Details

I. General information

NPI: 1144158403
Provider Name (Legal Business Name): ALIVIAH NOEL VIGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

5795 PARKSTONE CROSSING DR
JACKSONVILLE FL
32258-5429
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 719-922-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: