MEDICARE: SUE ANN ALLICOCK

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	376K00000X	Nurse's Aide	CNA263426	FL

General Provider Information

NPI Number	:	1477335420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN ALLICOCK

Provider Business Mailing Address
First Line	:	1401 VILLAGE BLVD APT 321
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-2762
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 VILLAGE BLVD APT 321
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-2762
Country	:	US
Telephone Number	:	561-389-1699
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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Directions to “ SUE ANN ALLICOCK ” Practice Location

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