Provider Demographics
NPI:1831447606
Name:VEGA, ALICIA LUISA (FNP)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:LUISA
Last Name:VEGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206A HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2989
Mailing Address - Country:US
Mailing Address - Phone:478-272-3525
Mailing Address - Fax:478-272-3589
Practice Address - Street 1:206A HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2989
Practice Address - Country:US
Practice Address - Phone:478-272-3525
Practice Address - Fax:478-272-3589
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily