Provider Demographics
NPI:1366611899
Name:ALANIZ, FREIDA NADIR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:FREIDA
Middle Name:NADIR
Last Name:ALANIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAR WALT DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-226-6801
Mailing Address - Fax:877-413-5104
Practice Address - Street 1:4457 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2601
Practice Address - Country:US
Practice Address - Phone:850-226-6801
Practice Address - Fax:877-413-5104
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19388363A00000X
AZ4391363AM0700X
FLPA9107135363AM0700X
FLPA9111848363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416051Medicaid
AZ1079363OtherNCCPA
AZMB1669261OtherDEA
AZ416051Medicaid