MEDICARE: ALISHA TIERA KING

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	363LF0000X	Family Nurse Practitioner	11040812	FL

General Provider Information

NPI Number	:	1962384214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA TIERA KING

Provider Business Mailing Address
First Line	:	2334 QUINCY ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-3447
Country	:	US
Telephone Number	:	727-317-8389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2334 QUINCY ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-3447
Country	:	US
Telephone Number	:	727-317-8389
Fax Number	:

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

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/29/2025

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