Individual
AYANA MATOKAH ARCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1420 SE 41ST AVE, GAINESVILLE, FL 32641-9261
(352) 871-5552
Mailing address
1420 SE 41ST AVE, GAINESVILLE, FL 32641-9261
(352) 871-5552
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012801400
—
FL
Enumeration date
05/12/2017
Last updated
05/12/2017
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