Provider Demographics
NPI:1245057652
Name:TYREE, ALICIA DANIELLE (RNFA)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DANIELLE
Last Name:TYREE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:JAMESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2752 S MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1169
Mailing Address - Country:US
Mailing Address - Phone:928-210-1696
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7170
Practice Address - Country:US
Practice Address - Phone:928-336-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN119153163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant