Provider Demographics
NPI:1659730422
Name:ODUMS, ALESIA D (ARNP)
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:D
Last Name:ODUMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALESIA
Other - Middle Name:
Other - Last Name:ODUMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP,FNP-C
Mailing Address - Street 1:3600 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1345
Mailing Address - Country:US
Mailing Address - Phone:727-322-4227
Mailing Address - Fax:
Practice Address - Street 1:3600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1345
Practice Address - Country:US
Practice Address - Phone:727-322-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9196935363LP2300X
FL9196935363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care