Provider Demographics
NPI:1881420552
Name:STARKS, ALIZAY (PA-C)
Entity type:Individual
Prefix:
First Name:ALIZAY
Middle Name:
Last Name:STARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2804 SAINT JOHNS BLUFF RD S STE 109
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3777
Mailing Address - Country:US
Mailing Address - Phone:904-454-8369
Mailing Address - Fax:
Practice Address - Street 1:2804 SAINT JOHNS BLUFF RD S STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3777
Practice Address - Country:US
Practice Address - Phone:904-454-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant