Provider Demographics
NPI:1538101589
Name:ROSARIO, ALICIA (PA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 VISTA VERDE DR E
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6910
Mailing Address - Country:US
Mailing Address - Phone:813-833-6160
Mailing Address - Fax:813-833-6160
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:OCCUPATIONAL HEALTH DEPARTMENT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6911ZMedicare ID - Type UnspecifiedFL MEDICARE