Healthcare Provider Details

I. General information

NPI: 1467824573
Provider Name (Legal Business Name): ALICIA CHIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VONDERBURG DR STE 310
BRANDON FL
33511-5978
US

IV. Provider business mailing address

10920 TECHNOLOGY TER
LAKEWOOD RANCH FL
34211-4930
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-5500
  • Fax: 813-653-1379
Mailing address:
  • Phone: 941-757-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 9200170
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9200170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: