Provider Demographics
NPI:1477193357
Name:GARCON, ALBERTE D
Entity Type:Individual
Prefix:
First Name:ALBERTE
Middle Name:D
Last Name:GARCON
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 1:9526 ARGYLE FOREST BLVD # B2327
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2825
Mailing Address - Country:US
Mailing Address - Phone:904-639-5130
Mailing Address - Fax:904-639-5180
Practice Address - Street 1:9526 ARGYLE FOREST BLVD # B2327
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2825
Practice Address - Country:US
Practice Address - Phone:904-639-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84-4317578OtherNON MEDICAL TRANSPORTATION