Healthcare Provider Details

I. General information

NPI: 1275907446
Provider Name (Legal Business Name): ALLISON KAYE RAYNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON KAYE MILLINER PA-C

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S US HIGHWAY 1
JUPITER FL
33477-7321
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7176
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-0510
  • Fax: 561-748-0598
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: