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NPI Code Detail

MEDICARE: MRS. STASHA-GAE ALICIA ROBERTS NURSE PRACTITIONER

MEDICARE: MRS. STASHA-GAE ALICIA ROBERTS NURSE PRACTITIONER
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
1363LA2200XAdult Health Nurse PractitionerAPRN9168956FL
2363LP2300XPrimary Care Nurse PractitionerAPRN9168956FL

General Provider Information

NPI Number : 1326443532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STASHA-GAE ALICIA ROBERTS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 10150 HIGHLAND MANOR DR STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33610-9712
Country : US
Telephone Number : 813-669-3084
Fax Number : 813-219-8836
Provider Business Practice Location Address
First Line : 10150 HIGHLAND MANOR DR STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33610-9712
Country : US
Telephone Number : 813-669-3084
Fax Number : 813-706-7077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2014
Last Update Date : 05/03/2024

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Directions to “ MRS. STASHA-GAE ALICIA ROBERTS NURSE PRACTITIONER” Practice Location

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