Provider Demographics
NPI:1356312052
Name:POE, ALICE H (MN, CNM, DSN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:H
Last Name:POE
Suffix:
Gender:F
Credentials:MN, CNM, DSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100197
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0197
Mailing Address - Country:US
Mailing Address - Phone:904-244-5174
Mailing Address - Fax:904-244-3246
Practice Address - Street 1:101 S NEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:904-244-5174
Practice Address - Fax:904-244-3246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1338112363LP2300X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife