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General NPI Number Information
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NPI Number | 1528918125
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Entity Type | Organization
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Legal Business Name | MLA ENT FL, INC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 12220 ATLANTIC BLVD STE 113
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City | JACKSONVILLE
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State | FL
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Zip | 32225-5826
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Country | US
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Telephone | 904-435-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 12220 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-5822
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Country | US
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Telephone | 904-435-4684
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALISON TEMPLE
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Credential | ADMIN
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Telephone | 817-655-2164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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