Healthcare Provider Details

I. General information

NPI: 1134984792
Provider Name (Legal Business Name): ALEXANDRA KIEWEG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 US HIGHWAY 17 STE 340
FLEMING ISLAND FL
32003-4825
US

IV. Provider business mailing address

66 MAGNOLIA DUNES CIR
ST AUGUSTINE FL
32080-6585
US

V. Phone/Fax

Practice location:
  • Phone: 904-526-7481
  • Fax:
Mailing address:
  • Phone: 513-316-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: