Provider Demographics
NPI:1427864602
Name:ALLEN GASKILL, ALYSSA JORDAN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JORDAN
Last Name:ALLEN GASKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 WILTSHIRE PARK PL
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1522
Mailing Address - Country:US
Mailing Address - Phone:321-848-0064
Mailing Address - Fax:
Practice Address - Street 1:7601 WILTSHIRE PARK PL
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1522
Practice Address - Country:US
Practice Address - Phone:321-848-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant