Provider Demographics
NPI:1013462308
Name:HANLON, ALICIA POOL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:POOL
Last Name:HANLON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ALICIA
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:612 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-2732
Mailing Address - Country:US
Mailing Address - Phone:352-409-4782
Mailing Address - Fax:
Practice Address - Street 1:612 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2732
Practice Address - Country:US
Practice Address - Phone:352-409-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9308692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily