Healthcare Provider Details

I. General information

NPI: 1326826512
Provider Name (Legal Business Name): ALICIA TEMBO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 17TH ST
COLUMBUS IN
47201-5417
US

IV. Provider business mailing address

2626 17TH ST
COLUMBUS IN
47201-5417
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-8000
  • Fax:
Mailing address:
  • Phone: 812-314-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09230211
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: