Provider Demographics
NPI:1760436919
Name:WOLFF, ALICIA A ALONSO (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:A ALONSO
Last Name:WOLFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7854
Mailing Address - Country:US
Mailing Address - Phone:407-331-1121
Mailing Address - Fax:407-331-1156
Practice Address - Street 1:631 PALM SPRINGS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-331-1121
Practice Address - Fax:407-331-1156
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1868672363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY004KOtherBCBS
P51575Medicare UPIN
FLY004KOtherBCBS