Healthcare Provider Details

I. General information

NPI: 1093484495
Provider Name (Legal Business Name): ALEXIS NICOLE DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 SE OCEAN BLVD
STUART FL
34996-3306
US

IV. Provider business mailing address

2110 SE OCEAN BLVD
STUART FL
34996-3306
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-1045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: