Provider Demographics
NPI:1386197341
Name:BALDASSARE, ALICIA JENNIFER (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JENNIFER
Last Name:BALDASSARE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 GRAPEVINE MILLS PKWY APT 2526
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 GRAPEVINE MILLS PKWY APT 2526
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-1939
Practice Address - Country:US
Practice Address - Phone:201-230-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX807308163W00000X
PARN621735163W00000X
MNR 241060-1363LF0000X
MNCNP 4887363LF0000X
TXAP135439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse