Provider Demographics
NPI:1922702463
Name:ALAMEDA FAMILY PRACTICE FL LLC
Entity Type:Organization
Organization Name:ALAMEDA FAMILY PRACTICE FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:PISETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-467-5855
Mailing Address - Street 1:12627 SAN JOSE BLVD STE 801
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8644
Mailing Address - Country:US
Mailing Address - Phone:904-467-5855
Mailing Address - Fax:505-387-3937
Practice Address - Street 1:12627 SAN JOSE BLVD STE 801
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8644
Practice Address - Country:US
Practice Address - Phone:904-467-5855
Practice Address - Fax:505-387-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty