Healthcare Provider Details

I. General information

NPI: 1588114722
Provider Name (Legal Business Name): ALEXANDER NACHLIS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ARDEN AVE STE 100
GLENDALE CA
91203-1166
US

IV. Provider business mailing address

17855 DALLAS PKWY STE 200
DALLAS TX
75287-6857
US

V. Phone/Fax

Practice location:
  • Phone: 866-278-7500
  • Fax: 847-375-2821
Mailing address:
  • Phone: 800-834-3059
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: