Healthcare Provider Details

I. General information

NPI: 1679581938
Provider Name (Legal Business Name): ALICE COOK LAXTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE ELIZABETH COOK RN

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

IV. Provider business mailing address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-1802
  • Fax: 850-644-4251
Mailing address:
  • Phone: 850-644-1802
  • Fax: 850-644-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP1522242
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP1522242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: