Basic Information
| Provider Information | |||||||||
| NPI: | 1245203983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKENS | ||||||||
| FirstName: | ALYCIA | ||||||||
| MiddleName: | THOMPSON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4440 FRUITVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342321926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660134 | ||||||||
| FaxNumber: | 9414041760 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 MONTICELLO AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235102564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573465770 | ||||||||
| FaxNumber: | 8662920928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001143467 | VA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 0024143467 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 007785551 | 05 | VA | MEDICAID | -032 | 01 | VA | TRICARE/CHAMPUS | OTHER | 93552N | 01 | VA | SENTARA OPTIMA | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER |