Provider Demographics
NPI:1356669063
Name:ALISSA, RANA (MD)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:ALISSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PRUDENTIAL DR
Mailing Address - Street 2:HOWARD BLDG, SUITE 614
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8210
Mailing Address - Country:US
Mailing Address - Phone:904-202-4212
Mailing Address - Fax:904-202-4219
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:HOWARD BLDG, SUITE 614
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-202-4212
Practice Address - Fax:904-202-4219
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN14670208000000X
FLME116456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137176AMedicaid
FL009409900Medicaid
FL14RF1OtherBCBS
FL009409900Medicaid