Healthcare Provider Details

I. General information

NPI: 1720489941
Provider Name (Legal Business Name): ALLISON JUSTICE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2014
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ROBERTS AVE
TALLAHASSEE FL
32310-5007
US

IV. Provider business mailing address

2911 ROBERTS AVE
TALLAHASSEE FL
32310-5007
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-1543
  • Fax:
Mailing address:
  • Phone: 850-644-1543
  • Fax: 855-230-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAT9108135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: