Provider Demographics
NPI:1184215261
Name:MCDONALD, ALISON VANNAH-FIALKA
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:VANNAH-FIALKA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:VANNAH
Other - Last Name:FIALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6907 CASA VERDE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2919
Mailing Address - Country:US
Mailing Address - Phone:248-318-0152
Mailing Address - Fax:
Practice Address - Street 1:1500 CONCORD TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2815
Practice Address - Country:US
Practice Address - Phone:954-232-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014408367500000X
FL9497811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse