Healthcare Provider Details

I. General information

NPI: 1376109777
Provider Name (Legal Business Name): ALEXIS ANNE JORGENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS ANNE BLIGHT

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 SURFSIDE BLVD STE 202
CAPE CORAL FL
33914-3861
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-541-7553
  • Fax: 239-343-4256
Mailing address:
  • Phone: 239-541-7553
  • Fax: 239-343-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME176085
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number25MA12296700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: