Provider Demographics
NPI:1285398032
Name:FLOYD, ALISIA
Entity type:Individual
Prefix:
First Name:ALISIA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALISIA
Other - Middle Name:
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2529 TANGLEWOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2807
Mailing Address - Country:US
Mailing Address - Phone:863-838-4445
Mailing Address - Fax:
Practice Address - Street 1:2529 TANGLEWOOD ST APT 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2807
Practice Address - Country:US
Practice Address - Phone:863-838-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237867251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health