Healthcare Provider Details

I. General information

NPI: 1912686684
Provider Name (Legal Business Name): ALEXANDRA COURTNEY CLOSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ELISEO DR STE 201
GREENBRAE CA
94904-2153
US

IV. Provider business mailing address

152 BLACKFIELD DR
TIBURON CA
94920-2037
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-1780
  • Fax:
Mailing address:
  • Phone: 617-549-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: