Healthcare Provider Details

I. General information

NPI: 1083308811
Provider Name (Legal Business Name): ANANYA KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CENTURION PKWY N
JACKSONVILLE FL
32256-5003
US

IV. Provider business mailing address

10112 ECTON LN
JACKSONVILLE FL
32246-1862
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-2050
  • Fax:
Mailing address:
  • Phone: 904-955-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: