Healthcare Provider Details

I. General information

NPI: 1386184349
Provider Name (Legal Business Name): CARLA AYALA SORIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

203 INDIGO DR
BRUNSWICK GA
31525-6865
US

V. Phone/Fax

Practice location:
  • Phone: 912-261-2669
  • Fax: 912-261-0561
Mailing address:
  • Phone: 912-261-2669
  • Fax: 912-261-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME182564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: