Provider Demographics
NPI:1780468090
Name:LASSETER, ALYSHA M (APRN)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:M
Last Name:LASSETER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:M
Other - Last Name:GILVARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8649 HEATHER RUN DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9535
Mailing Address - Country:US
Mailing Address - Phone:904-826-7441
Mailing Address - Fax:
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-652-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily