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: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MACCLENNY AVE
MACCLENNY FL
32063-2029
US

IV. Provider business mailing address

121 W MACCLENNY AVE
MACCLENNY FL
32063-2029
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-6380
  • Fax: 904-259-6340
Mailing address:
  • Phone: 904-259-6380
  • Fax: 904-259-6340

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: