Provider Demographics
NPI:1922882166
Name:THOMAS, ALICIA NICOLE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:NICOLE
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8795 KAYE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4189
Mailing Address - Country:US
Mailing Address - Phone:904-456-7413
Mailing Address - Fax:
Practice Address - Street 1:8795 KAYE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4189
Practice Address - Country:US
Practice Address - Phone:904-456-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL453120376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician