Healthcare Provider Details

I. General information

NPI: 1073356101
Provider Name (Legal Business Name): YOLA ALICJA DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLANTA PILAT- JOROFF RN

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 EDGEWOOD AVE W
JACKSONVILLE FL
32208-3260
US

IV. Provider business mailing address

4011 DELLWOOD AVE
JACKSONVILLE FL
32205-5429
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2437
  • Fax: 904-264-2330
Mailing address:
  • Phone: 904-487-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: