Provider Demographics
NPI:1366209256
Name:CAZZOLLA, ALICIA (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CAZZOLLA
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SAINT JOHNS GOLF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1080
Mailing Address - Country:US
Mailing Address - Phone:904-201-9729
Mailing Address - Fax:
Practice Address - Street 1:428 SAINT JOHNS GOLF DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1080
Practice Address - Country:US
Practice Address - Phone:904-201-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9280517163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant