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General NPI Number Information
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NPI Number | 1700064664
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Entity Type | Individual
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Provider Name | JACQUELINE ALEXANDRA ANDERSON PHD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2008
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Last Update Date | 10/22/2023
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Provider Practice Location Address
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Address Line | 2801 SW COLLEGE RD STE 3
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City | OCALA
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State | FL
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Zip | 34474-4430
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Country | US
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Telephone | 352-804-2875
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Fax | 352-390-3868
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Provider Business Mailing Address
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Address Line | PO BOX 772345
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City | OCALA
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State | FL
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Zip | 34477-2345
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Country | US
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Telephone | 786-246-0656
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Fax | 325-390-3868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY5982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5982
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License Number State | FL
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