Provider Demographics
NPI:1932790698
Name:DILISA, ALECIA LYNETTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:LYNETTE
Last Name:DILISA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:LYNETTE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:215 WILCOX ST APT 2323
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2563
Mailing Address - Country:US
Mailing Address - Phone:405-990-9468
Mailing Address - Fax:
Practice Address - Street 1:720 ELKTON DR # 175
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3516
Practice Address - Country:US
Practice Address - Phone:719-400-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-RXN.0001215-C-NP363LF0000X
CO-APN.0002609-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily