Healthcare Provider Details

I. General information

NPI: 1598251910
Provider Name (Legal Business Name): ALLIONZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 DUNN AVE STE 109
JACKSONVILLE FL
32218-4751
US

IV. Provider business mailing address

9250 CYPRESS GREEN DR
JACKSONVILLE FL
32256-1885
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2437
  • Fax: 904-264-2330
Mailing address:
  • Phone: 904-269-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TANYA ALCANTARA
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-269-2437