Healthcare Provider Details

I. General information

NPI: 1043802531
Provider Name (Legal Business Name): ALISHA RYAN ALEXANDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 W HIBISCUS BLVD
MELBOURNE FL
32901-2639
US

IV. Provider business mailing address

3373 GOVAN AVE
MALABAR FL
32950-3839
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-3200
  • Fax:
Mailing address:
  • Phone: 132-147-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: