Provider Demographics
NPI:1003510751
Name:ESTRADA, ALICIA (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2693
Mailing Address - Country:US
Mailing Address - Phone:773-614-7296
Mailing Address - Fax:866-707-2267
Practice Address - Street 1:4952 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2693
Practice Address - Country:US
Practice Address - Phone:773-614-7296
Practice Address - Fax:866-707-2267
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027006363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care