Healthcare Provider Details

I. General information

NPI: 1013735273
Provider Name (Legal Business Name): ALEXA BLOOD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXA HERLANDS

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

14 SHAW DR
NORTH HAVEN CT
06473-2724
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2565
  • Fax:
Mailing address:
  • Phone: 475-201-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13929
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: