Healthcare Provider Details

I. General information

NPI: 1972209666
Provider Name (Legal Business Name): ALYSSA MARIE HOUSEHOLDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 N BELCHER RD STE F1
CLEARWATER FL
33765-1453
US

IV. Provider business mailing address

3001 EXECUTIVE DR STE 130
CLEARWATER FL
33762-5323
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-4544
  • Fax:
Mailing address:
  • Phone: 727-347-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: