Provider Demographics
NPI:1821589896
Name:ALICEA-NIEVES, TAMARA (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:ALICEA-NIEVES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SEABOARD LN STE 200B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8282
Mailing Address - Country:US
Mailing Address - Phone:929-402-2408
Mailing Address - Fax:800-266-5158
Practice Address - Street 1:10739 DEERWOOD PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-719-7707
Practice Address - Fax:866-509-6155
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9302699163W00000X
FLARNP9302699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse