Provider Demographics
NPI:1699430173
Name:ALONSO, TAILY (APRN)
Entity type:Individual
Prefix:
First Name:TAILY
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAILY
Other - Middle Name:
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4241 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4881
Mailing Address - Country:US
Mailing Address - Phone:386-288-5311
Mailing Address - Fax:386-288-0058
Practice Address - Street 1:4241 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4881
Practice Address - Country:US
Practice Address - Phone:386-288-5311
Practice Address - Fax:386-288-0058
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily