Provider Demographics
NPI:1760937155
Name:WAKEFIELD, ASZLOYN NIKITA (EDS)
Entity Type:Individual
Prefix:
First Name:ASZLOYN
Middle Name:NIKITA
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12280 SUMTER SQUARE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6125
Mailing Address - Country:US
Mailing Address - Phone:904-622-8684
Mailing Address - Fax:904-765-0011
Practice Address - Street 1:12280 SUMTER SQUARE DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6125
Practice Address - Country:US
Practice Address - Phone:904-622-8684
Practice Address - Fax:904-765-0011
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator