Healthcare Provider Details

I. General information

NPI: 1346807625
Provider Name (Legal Business Name): ALEXANDRA FELIZ CAMILO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 VETERANS BLVD UNIT 9
PORT CHARLOTTE FL
33954-1037
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 941-263-1776
  • Fax:
Mailing address:
  • Phone: 941-456-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: