Healthcare Provider Details

I. General information

NPI: 1740197862
Provider Name (Legal Business Name): ALEXANDRA TAYLOR SHROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10493 HARRIER ST
PLANTATION FL
33324-2163
US

IV. Provider business mailing address

10493 HARRIER ST
PLANTATION FL
33324-2163
US

V. Phone/Fax

Practice location:
  • Phone: 954-559-2599
  • Fax:
Mailing address:
  • Phone: 954-559-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN9441451
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9441451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: