Provider Demographics
NPI:1780943811
Name:LIDGE, ALECIA SUE (PA)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:SUE
Last Name:LIDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-905-8998
Practice Address - Street 1:225 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5327
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-886-4282
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2023-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant