Healthcare Provider Details

I. General information

NPI: 1649599283
Provider Name (Legal Business Name): ALEXIS KROGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS DALESSANDRO

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 FLORA VISTA DR
ORLANDO FL
32837-4793
US

IV. Provider business mailing address

10032 BEAR LAKE RD
APOPKA FL
32703-1928
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-6285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: