Alice Lillian Abdur-Razzaaq, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11034345 Issued in FL

Practice address

1636 Shadowood Lane
Suite 120
Jacksonville, FL 32207-2187

Phone

(904) 725-9701

Fax

(904) 725-9694

NPI assigned

Aug 22, 2024

Last updated

Aug 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bold City Behavioral Health

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1295607828
  NPD Authorized official
• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1376216945
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1245063494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 SHADOWOOD LN STE 120",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072187",
            "telephone_number": "904-725-9701",
            "fax_number": "904-725-9694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 SHADOWOOD LANE",
            "address_2": "SUITE 120",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072187",
            "telephone_number": "904-725-9701",
            "fax_number": "904-725-9694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2631 Forbes St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044224",
            "country_code": "US",
            "telephone_number": "619-483-9330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABDUR-RAZZAAQ",
        "first_name": "ALICE",
        "middle_name": "LILLIAN",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11034345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rasheed Abdullah, CAP
• Shukri Abdullah, MD
• Ahmad Yaser Abdulzahir
• Asma Abdur-Rahman
• Mubarak N Abdur-Rahman, MD
• Juliann Abecassis
• Afrah Syeda Abedi, DO
• Maleeha Syeda Abedi, DO
• Judith Isabelle Abel, LPC
• Martin Abel, MD

• Psychiatric/Mental Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.