=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619443454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE ANGELA ALIANO ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2018
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 KAY LARKIN DR
-----------------------------------------------------
City | PALATKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32177-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-539-4228
-----------------------------------------------------
Fax | 386-385-1269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 MAGNOLIA AVE
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-236-3225
-----------------------------------------------------
Fax | 386-236-3178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN9234661
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 9234661
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------