Healthcare Provider Details

I. General information

NPI: 1083673412
Provider Name (Legal Business Name): ALEX B BAHADORI DNP, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10036 WHISPER RIDGE TRL
WEEKI WACHEE FL
34613-6532
US

IV. Provider business mailing address

10036 WHISPER RIDGE TRL
WEEKI WACHEE FL
34613-6532
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-6228
  • Fax:
Mailing address:
  • Phone: 352-684-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3287252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: