Healthcare Provider Details

I. General information

NPI: 1699309492
Provider Name (Legal Business Name): JOSIANE ALEXANDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BLUE HILLS AVE
BLOOMFIELD CT
06002-1151
US

IV. Provider business mailing address

1551 BLUE HILLS AVE
BLOOMFIELD CT
06002-1151
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-7834
  • Fax:
Mailing address:
  • Phone: 860-242-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8195
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: