Provider Demographics
NPI:1174966535
Name:CARMONA, ANIXA ELENA (MACP)
Entity type:Individual
Prefix:
First Name:ANIXA
Middle Name:ELENA
Last Name:CARMONA
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:ANIXA
Other - Middle Name:ELENA
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44230
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4230
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 510
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8966
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional