MEDICARE: MRS. FREIDA NADIR ALANIZ PA-C

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
1	363AM0700X	Medical Physician Assistant	4391	AZ
2	363AM0700X	Medical Physician Assistant	PA9107135	FL
3	363A00000X	Physician Assistant	PA19388	CA
4	363AM0700X	Medical Physician Assistant	PA9111848	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1079363	OTHER	AZ	NCCPA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366611899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FREIDA NADIR ALANIZ PA-C

Provider Business Mailing Address
First Line	:	PO BOX 95590
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0590
Country	:	US
Telephone Number	:	801-784-0954
Fax Number	:	801-352-7976

Provider Business Practice Location Address
First Line	:	5100 N 12TH AVE STE 101
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-8919
Country	:	US
Telephone Number	:	850-208-6130
Fax Number	:	850-208-6136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/03/2026

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