Healthcare Provider Details

I. General information

NPI: 1043687619
Provider Name (Legal Business Name): ALEXANDRIA WEST DIEGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2015
Last Update Date: 02/10/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 S PINE ISLAND RD STE 410
PLANTATION FL
33324-4583
US

IV. Provider business mailing address

PO BOX 743144
ATLANTA GA
30374-3144
US

V. Phone/Fax

Practice location:
  • Phone: 954-837-1490
  • Fax: 954-837-1188
Mailing address:
  • Phone: 954-837-1490
  • Fax: 954-837-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9262193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: