Healthcare Provider Details

I. General information

NPI: 1174000202
Provider Name (Legal Business Name): ALEXANDER JORGE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 NW 107TH AVE
SWEETWATER FL
33172-2508
US

IV. Provider business mailing address

9773 NW 31ST ST
DORAL FL
33172-1014
US

V. Phone/Fax

Practice location:
  • Phone: 305-916-9136
  • Fax:
Mailing address:
  • Phone: 305-916-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06180471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: