Provider Demographics
NPI:1700064664
Name:ANDERSON, JACQUELINE ALEXANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ALEXANDRA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772345
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-2345
Mailing Address - Country:US
Mailing Address - Phone:786-246-0656
Mailing Address - Fax:325-390-3868
Practice Address - Street 1:2801 SW COLLEGE RD STE 3
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4430
Practice Address - Country:US
Practice Address - Phone:352-804-2875
Practice Address - Fax:352-390-3868
Is Sole Proprietor?:No
Enumeration Date:2008-02-03
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5982103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist