Provider Demographics
NPI:1245786474
Name:CRAIG-RODRIGUEZ, ALICIA ANNE (DNP, MBA, ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:CRAIG-RODRIGUEZ
Suffix:
Gender:F
Credentials:DNP, MBA, ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 LAUREL VALLEY AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4009
Mailing Address - Country:US
Mailing Address - Phone:941-587-3192
Mailing Address - Fax:
Practice Address - Street 1:9913 LAUREL VALLEY AVE CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-4009
Practice Address - Country:US
Practice Address - Phone:941-587-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2616102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily