Provider Demographics
NPI:1053881995
Name:BODEN, ALISON LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALISON
Middle Name:LYNN
Last Name:BODEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:LYNN
Other - Last Name:RIEGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4461
Mailing Address - Country:US
Mailing Address - Phone:904-276-4500
Mailing Address - Fax:
Practice Address - Street 1:2055 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4461
Practice Address - Country:US
Practice Address - Phone:904-276-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant