Healthcare Provider Details

I. General information

NPI: 1255912861
Provider Name (Legal Business Name): ALEXANDRA HEIDTMANN NOBRE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/01/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 OUTER RD STE C
ORLANDO FL
32814-6688
US

IV. Provider business mailing address

899 OUTER RD STE C
ORLANDO FL
32814-6688
US

V. Phone/Fax

Practice location:
  • Phone: 407-228-2838
  • Fax:
Mailing address:
  • Phone: 407-228-2838
  • Fax: 407-894-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: