Healthcare Provider Details

I. General information

NPI: 1083562474
Provider Name (Legal Business Name): ALEXANDRA KUSTURISS BOARD CERTIFIED HHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 SEA BREEZE DR
TARPON SPRINGS FL
34689-2028
US

IV. Provider business mailing address

2636 ST JOSEPHS DR W
DUNEDIN FL
34698-1753
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-0875
  • Fax:
Mailing address:
  • Phone: 727-641-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: