Healthcare Provider Details

I. General information

NPI: 1447802541
Provider Name (Legal Business Name): ALEXIS RYAN CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ALEXIS CIERA FOX

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BURLAND CIR
WINTER GARDEN FL
34787-2189
US

IV. Provider business mailing address

35 SEAGOING TRL FL 32164
PALM COAST FL
32164-5546
US

V. Phone/Fax

Practice location:
  • Phone: 407-473-0786
  • Fax:
Mailing address:
  • Phone: 407-473-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberSBD20110775
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number315310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: