Provider Demographics
NPI:1366221905
Name:CILIEZAR, ALICIA MARIA (APRN)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIA
Last Name:CILIEZAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5507
Mailing Address - Country:US
Mailing Address - Phone:786-213-1152
Mailing Address - Fax:
Practice Address - Street 1:2010 NW 150TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2888
Practice Address - Country:US
Practice Address - Phone:954-719-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health