MEDICARE: ALICIA MONIQUE LAFOND

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	363LP0200X	Pediatric Nurse Practitioner	11003343	FL

General Provider Information

NPI Number	:	1588219604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MONIQUE LAFOND

Provider Business Mailing Address
First Line	:	901 E KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3502
Country	:	US
Telephone Number	:	813-273-7020
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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Directions to “ ALICIA MONIQUE LAFOND ” Practice Location

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