Healthcare Provider Details

I. General information

NPI: 1366221905
Provider Name (Legal Business Name): ALICIA MARIA CILIEZAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 NW 150TH AVE STE 120
PEMBROKE PINES FL
33028-2888
US

IV. Provider business mailing address

12855 SW 50TH ST
MIRAMAR FL
33027-5507
US

V. Phone/Fax

Practice location:
  • Phone: 954-719-6280
  • Fax:
Mailing address:
  • Phone: 786-213-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11028740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: