Provider Demographics
NPI:1205898517
Name:PHOENIX, AVA E (MD)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:E
Last Name:PHOENIX
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NORTH DAVIS ST
Mailing Address - Street 2:BUILDING A, SUITE 251
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-253-1639
Mailing Address - Fax:
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1463
Practice Address - Country:US
Practice Address - Phone:904-296-5688
Practice Address - Fax:904-296-5699
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74279207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118880000Medicaid
FL265653100Medicaid
FL265653100Medicaid