Healthcare Provider Details

I. General information

NPI: 1023955457
Provider Name (Legal Business Name): AVERY OGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 CORPORATE CENTER PKWY STE 115
JACKSONVILLE FL
32216-8088
US

IV. Provider business mailing address

6675 CORPORATE CENTER PKWY STE 115
JACKSONVILLE FL
32216-8088
US

V. Phone/Fax

Practice location:
  • Phone: 904-245-8910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: