MEDICARE: ALEXANDRA KITCHENER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN11003723	FL

General Provider Information

NPI Number	:	1629616552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA KITCHENER APRN

Provider Business Mailing Address
First Line	:	1620 TAMIAMI TRAIL
Second Line	:	SUITE 308
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-246-2482
Fax Number	:	941-979-9074

Provider Business Practice Location Address
First Line	:	1620 TAMIAMI TRAIL
Second Line	:	SUITE 308
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-246-2482
Fax Number	:	941-979-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	11/03/2025

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