Provider Demographics
NPI:1598311003
Name:FRISBEY, ALEXA JANE
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JANE
Last Name:FRISBEY
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 1:4850 FIRST COAST TECH PKWY APT 8208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0684
Mailing Address - Country:US
Mailing Address - Phone:570-687-5511
Mailing Address - Fax:
Practice Address - Street 1:9000 CYPRESS GREEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7791
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician