Provider Demographics
NPI:1497175335
Name:HALSEMA, ALLISON CULPEPPER (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:CULPEPPER
Last Name:HALSEMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ALLISON
Other - Last Name:CULPEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4830 W. KENNEDY BLVD SUITE 440
Mailing Address - Street 2:IDEAL IMAGE CORPORATION
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-340-4124
Mailing Address - Fax:
Practice Address - Street 1:4830 W. KENNEDY BLVD SUITE 440
Practice Address - Street 2:IDEAL IMAGE CORPORATION
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-340-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230710363LF0000X
TN19796363LF0000X
CT5341363LF0000X
FL9272904363LF0000X
IDNP-1285A363LF0000X
MDR205671363LF0000X
MI4704302059363LF0000X
MNR212893-5363LF0000X
KY30080000363LF0000X
NC143605363LF0000X
NE111639363LF0000X
NY338342363LF0000X
OR201391901 NP-PP363LF0000X
RINPP37800363LF0000X
TX838551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily