Provider Demographics
NPI:1255701116
Name:HENTKOWSKI, ALLISON BETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:BETH
Last Name:HENTKOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:BETH
Other - Last Name:BLINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-7205
Mailing Address - Fax:904-396-4047
Practice Address - Street 1:150 LONGLEAF PINE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7529
Practice Address - Country:US
Practice Address - Phone:904-652-0800
Practice Address - Fax:904-652-0811
Is Sole Proprietor?:No
Enumeration Date:2015-10-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109048363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical