Provider Demographics
NPI:1275869281
Name:KAVANAGH, ALLISON SCHAEFER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SCHAEFER
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2735 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2548
Mailing Address - Country:US
Mailing Address - Phone:904-721-0894
Mailing Address - Fax:904-721-0991
Practice Address - Street 1:2735 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2548
Practice Address - Country:US
Practice Address - Phone:904-721-0894
Practice Address - Fax:904-721-0991
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9292448363LA2100X
NY430590363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM8550OtherMEDICARE RR
FLEO909ZMedicare PIN