Provider Demographics
NPI:1235372970
Name:PIAZZA, ALLISHA LANIER (ARNP)
Entity Type:Individual
Prefix:
First Name:ALLISHA
Middle Name:LANIER
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALLISHA
Other - Middle Name:N
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:352-273-6818
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0277
Practice Address - Country:US
Practice Address - Phone:352-265-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9290938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011061100Medicaid
FLHT852ZMedicare PIN