Healthcare Provider Details

I. General information

NPI: 1063817732
Provider Name (Legal Business Name): JUDE ADLER ALEXA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 N 24TH ST
TAMPA FL
33610-1312
US

IV. Provider business mailing address

6704 N 24TH ST
TAMPA FL
33610-1312
US

V. Phone/Fax

Practice location:
  • Phone: 727-564-1160
  • Fax:
Mailing address:
  • Phone: 727-564-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA420421653880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: