Healthcare Provider Details

I. General information

NPI: 1386537165
Provider Name (Legal Business Name): ALYSSA ANNE RUDOLPH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 S JOG RD STE 215
DELRAY BEACH FL
33446-2170
US

IV. Provider business mailing address

15340 S JOG RD STE 215
DELRAY BEACH FL
33446-2170
US

V. Phone/Fax

Practice location:
  • Phone: 561-559-9800
  • Fax:
Mailing address:
  • Phone: 561-559-9800
  • Fax: 561-559-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: