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Individual

ALYSSA L MACCA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
5140 HIGHLANDS BY THE LAKE DR, LAKELAND, FL 33812-3083
(863) 640-8500
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9204843
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01904
UNIVERSAL
FL
01
200731387
TRICARE
FL
05
269836600
FL
01
301304
AVMED
FL
01
37919Z
BCBS PROVIDER #
FL
01
U7175X
MEDICARE PTAN
01
Y12VV
BCBS
FL
Enumeration date
11/29/2006
Last updated
02/22/2021
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