Provider Demographics
NPI:1699220277
Name:AZEMAR, ALISHA CHRISTIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:CHRISTIE ELIZABETH
Last Name:AZEMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N FLAGLER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3429
Mailing Address - Country:US
Mailing Address - Phone:561-249-2279
Mailing Address - Fax:561-720-2970
Practice Address - Street 1:1515 N FLAGLER DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3429
Practice Address - Country:US
Practice Address - Phone:561-249-2279
Practice Address - Fax:561-720-2970
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9336221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018886200Medicaid