MEDICARE: ALICIA M. PETERSON A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP 9243506	FL

General Provider Information

NPI Number	:	1790710846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA M. PETERSON A.R.N.P.

Provider Business Mailing Address
First Line	:	2975 14TH AVE NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-5512
Country	:	US
Telephone Number	:	239-919-8615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 14TH AVE NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-5512
Country	:	US
Telephone Number	:	239-919-8615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/01/2015

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