Healthcare Provider Details

I. General information

NPI: 1215382510
Provider Name (Legal Business Name): ALEXANDRA DANIELLE WALTERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SE 16TH AVE STE 303
OCALA FL
34471-4620
US

IV. Provider business mailing address

10510 YORKSTONE DR
BONITA SPRINGS FL
34135-5183
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0288
  • Fax: 352-867-1053
Mailing address:
  • Phone: 314-229-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: