Provider Demographics
NPI:1396404844
Name:WADE, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOMEMAKER
Mailing Address - Street 1:2032 WHITNER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-5535
Mailing Address - Country:US
Mailing Address - Phone:352-256-2861
Mailing Address - Fax:
Practice Address - Street 1:2032 WHITNER ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-5535
Practice Address - Country:US
Practice Address - Phone:352-256-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker