Provider Demographics
NPI:1104585629
Name:SACKS, ALICIA M (CRNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:SACKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 819 BOX 18
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0001
Mailing Address - Country:US
Mailing Address - Phone:314-727-3305
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL AMERICANO- BASE NAVAL DE ROTA
Practice Address - Street 2:APARTADO DE CORREOS 33
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:11530
Practice Address - Country:ES
Practice Address - Phone:314-727-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR235309363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal