Healthcare Provider Details

I. General information

NPI: 1952535023
Provider Name (Legal Business Name): ALLEYNE ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 KISSIMMEE PARK RD
SAINT CLOUD FL
34772-9182
US

IV. Provider business mailing address

4525 KISSIMMEE PARK RD
SAINT CLOUD FL
34772-9182
US

V. Phone/Fax

Practice location:
  • Phone: 917-790-9147
  • Fax:
Mailing address:
  • Phone: 917-790-9147
  • Fax: 718-462-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11048359
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number566971
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number9499997
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11048359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: