Healthcare Provider Details

I. General information

NPI: 1225950801
Provider Name (Legal Business Name): DYLAN ANDREW ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4228 CAMELLIA CIR W
JACKSONVILLE FL
32207-7027
US

IV. Provider business mailing address

4228 CAMELLIA CIR W
JACKSONVILLE FL
32207-7027
US

V. Phone/Fax

Practice location:
  • Phone: 352-281-9196
  • Fax:
Mailing address:
  • Phone: 352-281-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9521677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: