Healthcare Provider Details

I. General information

NPI: 1770868796
Provider Name (Legal Business Name): ALICIA LASHAWN PARKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 N 22ND STREET
TAMPA DC
33610
US

IV. Provider business mailing address

8607 CARLEY SOUND CIRCLE
TAMPA FL
33697
US

V. Phone/Fax

Practice location:
  • Phone: 813-272-2244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberARNP 3355632
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP3355632
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP3355632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: