Provider Demographics
NPI:1801648449
Name:KRIECH, ALISHA MICHELLE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:KRIECH
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9561
Mailing Address - Fax:
Practice Address - Street 1:8725 N WICKHAM RD STE 302
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2240
Practice Address - Country:US
Practice Address - Phone:321-434-9561
Practice Address - Fax:321-434-9231
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125063100Medicaid
FLT9536OtherMEDICARE HF