Basic Information
Provider Information
NPI: 1184964132
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASSON
FirstName: AVRIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1137
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329021137
CountryCode: US
TelephoneNumber: 3219529696
FaxNumber: 3219527937
Practice Location
Address1: 220 BARTON BLVD
Address2: UNIT C14
City: ROCKLEDGE
State: FL
PostalCode: 329552742
CountryCode: US
TelephoneNumber: 3216395177
FaxNumber: 3216394927
Other Information
ProviderEnumerationDate: 02/27/2013
LastUpdateDate: 12/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X9274855FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home