Healthcare Provider Details

I. General information

NPI: 1326060203
Provider Name (Legal Business Name): ALEX LLARENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S 14TH ST STE B
FERNANDINA BEACH FL
32034-3092
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-7221
  • Fax: 904-261-1857
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME48564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: