Provider Demographics
NPI:1215676291
Name:FLETCHER, ALISSA D (APRN)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:D
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 BELFORT PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6951
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:700 3RD ST STE 302
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5082
Practice Address - Country:US
Practice Address - Phone:904-997-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019919363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114621300Medicaid
FL34QZEOtherFL BLUE