Basic Information
| Provider Information | |||||||||
| NPI: | 1093109357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYETT | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4828 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504778109 | ||||||||
| FaxNumber: | 8504765313 | ||||||||
| Practice Location | |||||||||
| Address1: | 4531 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364563 | ||||||||
| FaxNumber: | 8504364570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9281658 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | ID491Y | 01 | FL | MCR FL | OTHER | Y0R06 | 01 | FL | BCBS | OTHER | 015194000 | 05 | FL | MEDICAID |