Provider Demographics
NPI:1326308776
Name:TATE, ALICIA A (ANP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:TATE
Suffix:
Gender:F
Credentials:ANP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BABYLON TPKE UNIT 359
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-4025
Mailing Address - Country:US
Mailing Address - Phone:516-642-5643
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE STE 154
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5162
Practice Address - Country:US
Practice Address - Phone:631-427-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305236-1363LA2200X
NY402781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health