Individual
DR. AGNES ELIZABETH AYSOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, UFJP PATHOLOGY DEPT., JACKSONVILLE, FL 32209-6511
(904) 244-4387
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
42392
MN
207ZB0001X
Blood Banking & Transfusion Medicine Physician
ME103131
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
42392
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME103131
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005352-00
—
FL
05
—
0559724
—
IA
01
—
1032019
PREFERRED ONE
MN
01
—
1032020
UCARE
MN
01
—
11-00014
MEDICA PRIMARY
MN
01
—
11-00245
MEDICA CHOICE
MN
01
—
1692251
ARAZ
MN
01
—
258A6AY
BCBS
MN
05
—
313506441A
—
GA
05
—
34309100
—
WI
05
—
587447500
—
MN
01
—
HP38358
HEALTHPARTNERS
MN
Enumeration date
06/16/2006
Last updated
06/10/2009
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