Provider Demographics
NPI:1346317047
Name:MACCA, ALYSSA L (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:MACCA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:NICOLE
Other - Last Name:LIGUORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5140 HIGHLANDS BY THE LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-3083
Practice Address - Country:US
Practice Address - Phone:863-640-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9204843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01904OtherUNIVERSAL
FL301304OtherAVMED
FL200731387OtherTRICARE
FL37919ZOtherBCBS PROVIDER #
FLY12VVOtherBCBS
FL200731387OtherHUMANA
FL269836600Medicaid
U7175XOtherMEDICARE PTAN
FL200731387OtherHUMANA