Provider Demographics
NPI:1073356101
Name:DAVIDSON, YOLA ALICJA
Entity type:Individual
Prefix:
First Name:YOLA
Middle Name:ALICJA
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOLANTA
Other - Middle Name:
Other - Last Name:PILAT- JOROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4011 DELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5429
Mailing Address - Country:US
Mailing Address - Phone:904-487-3150
Mailing Address - Fax:
Practice Address - Street 1:1740 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3260
Practice Address - Country:US
Practice Address - Phone:904-269-2437
Practice Address - Fax:904-264-2330
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily