Healthcare Provider Details

I. General information

NPI: 1538793849
Provider Name (Legal Business Name): ALBERTO KRIS CIPOLLONE IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 04/10/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE BUILDING 2104
JACKSONVILLE FL
32228
US

IV. Provider business mailing address

2104 MASSEY AVE BUILDING 104
JACKSONVILLE FL
32228
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4386
  • Fax:
Mailing address:
  • Phone: 904-270-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: