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Individual

AVA E PHOENIX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
4203 BELFORT RD, SUITE 204, JACKSONVILLE, FL 32216-1463
(904) 296-5688
(904) 296-5699
Mailing address
921 NORTH DAVIS ST, BUILDING A, SUITE 251, JACKSONVILLE, FL 32209
(904) 253-1639

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME74279
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
118880000
FL
05
265653100
FL
Enumeration date
04/03/2006
Last updated
05/02/2025
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