MEDICARE: AAILYAH GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689477135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AAILYAH GREEN

Provider Business Mailing Address
First Line	:	8789 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8789 SAN JOSE BLVD STE 305
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4282
Country	:	US
Telephone Number	:	904-383-1038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	04/07/2025

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Directions to “ AAILYAH GREEN ” Practice Location

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