Provider Demographics
NPI:1932853694
Name:SPICER, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:SPICER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 CAROLINE ST # 4449
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4582
Mailing Address - Country:US
Mailing Address - Phone:850-623-0133
Mailing Address - Fax:
Practice Address - Street 1:6501 CAROLINE ST # 4449
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4582
Practice Address - Country:US
Practice Address - Phone:850-623-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183681363LF0000X
FL11018559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily