Provider Demographics
NPI:1225393002
Name:SORENSEN, ALICIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:PRIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:122 OUTLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1141
Mailing Address - Country:US
Mailing Address - Phone:914-548-4172
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily