Healthcare Provider Details

I. General information

NPI: 1699412627
Provider Name (Legal Business Name): ALESSA LEIGH CRANER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 TURKEY LAKE ROAD
ORLANDO FL
32819
US

IV. Provider business mailing address

1011 VASSAR ST
ORLANDO FL
32804-4926
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11019404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: