Provider Demographics
NPI:1194042036
Name:HASKINS, ALICE JACQUELINE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:JACQUELINE
Last Name:HASKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3636
Mailing Address - Country:US
Mailing Address - Phone:919-407-3562
Mailing Address - Fax:
Practice Address - Street 1:100 PIEDMONT RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3636
Practice Address - Country:US
Practice Address - Phone:919-407-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010499363LF0000X
GA286041363LF0000X
NC234600163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator