Provider Demographics
NPI:1245203983
Name:DICKENS, ALYCIA THOMPSON (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALYCIA
Middle Name:THOMPSON
Last Name:DICKENS
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 1:4440 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1926
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1001 MONTICELLO AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2564
Practice Address - Country:US
Practice Address - Phone:757-346-5770
Practice Address - Fax:866-292-0928
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001143467163W00000X
VA0024143467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VA007785551Medicaid
VA-032OtherTRICARE/CHAMPUS
VA93552NOtherSENTARA OPTIMA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
NC14012OtherBC/BS
VAPAROtherVIRGINIA HEALTH NETWORK