Healthcare Provider Details

I. General information

NPI: 1114844131
Provider Name (Legal Business Name): ALICIA S EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 510
JACKSONVILLE FL
32207-8207
US

IV. Provider business mailing address

PO BOX 748519
ATLANTA GA
30374-8519
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax: 904-390-7398
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-376-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11048222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: