Provider Demographics
NPI:1245754167
Name:RANSOM, ALYSSA R (CNA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:RANSOM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6156 ARDISIA RD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-2032
Mailing Address - Country:US
Mailing Address - Phone:904-517-0221
Mailing Address - Fax:
Practice Address - Street 1:6156 ARDISIA RD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2032
Practice Address - Country:US
Practice Address - Phone:904-517-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA158271376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide