Provider Demographics
NPI:1043032196
Name:ALS, IMANI NIA (LPN)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:NIA
Last Name:ALS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S ORANGE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3411
Mailing Address - Country:US
Mailing Address - Phone:352-272-6713
Mailing Address - Fax:321-326-1028
Practice Address - Street 1:255 S ORANGE AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3411
Practice Address - Country:US
Practice Address - Phone:352-272-6713
Practice Address - Fax:321-326-1028
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002096899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse