Provider Demographics
NPI:1437383387
Name:WOOLDRIDGE, ALICIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:L
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:L
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:202 LAKE MIRIAM DR STE E4
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2198
Mailing Address - Country:US
Mailing Address - Phone:863-225-3355
Mailing Address - Fax:863-473-9191
Practice Address - Street 1:202 LAKE MIRIAM DR STE E4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2198
Practice Address - Country:US
Practice Address - Phone:863-225-3355
Practice Address - Fax:863-473-9191
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4233207Q00000X
OK27123207Q00000X
FLME150155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320647603Medicaid