Healthcare Provider Details

I. General information

NPI: 1215370713
Provider Name (Legal Business Name): ALEXANDRA HARTLEY AP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 HOMEWOOD DR
BELLE ISLE FL
32809-6110
US

IV. Provider business mailing address

2511 HOMEWOOD DR
BELLE ISLE FL
32809-6110
US

V. Phone/Fax

Practice location:
  • Phone: 407-924-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: