Provider Demographics
NPI:1386019685
Name:DIMITRIJEVIC, ALICIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:DIMITRIJEVIC
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:ELAINE
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3190 N MCMULLEN BOOTH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2013
Mailing Address - Country:US
Mailing Address - Phone:813-855-2900
Mailing Address - Fax:813-855-2990
Practice Address - Street 1:3190 N MCMULLEN BOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2013
Practice Address - Country:US
Practice Address - Phone:813-855-2900
Practice Address - Fax:813-855-2990
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9247285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily