Healthcare Provider Details

I. General information

NPI: 1598481640
Provider Name (Legal Business Name): ALEXIS JEZAK MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N FEDERAL HWY
FORT LAUDERDALE FL
33308-2600
US

IV. Provider business mailing address

5700 N FEDERAL HWY
FORT LAUDERDALE FL
33308-2600
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-1800
  • Fax:
Mailing address:
  • Phone: 954-776-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11022356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: