Healthcare Provider Details

I. General information

NPI: 1194634709
Provider Name (Legal Business Name): ALEXIS KIM HALL PHD DNP APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 SW 30TH AVE
GAINESVILLE FL
32608-0229
US

IV. Provider business mailing address

11880 SW 30TH AVE
GAINESVILLE FL
32608-0229
US

V. Phone/Fax

Practice location:
  • Phone: 352-672-0823
  • Fax:
Mailing address:
  • Phone: 352-672-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9564643
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050572
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11050572
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11050572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: