=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073910071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORALIZA JEAN-LOUIS A.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2014
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10175 FORTUNE PKWY UNIT 901
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-6755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-802-3418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 CALLISTO WAY
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-1229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-802-3428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP3421
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------