Healthcare Provider Details

I. General information

NPI: 1124954854
Provider Name (Legal Business Name): KATHRYN ALYSSA DZIWULSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 500
JACKSONVILLE FL
32216-7405
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-1912
  • Fax:
Mailing address:
  • Phone: 904-396-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY3012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: