Healthcare Provider Details

I. General information

NPI: 1942021167
Provider Name (Legal Business Name): SUSAN LANG ALEXANDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 100
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

233 E MURIEL ST
ORLANDO FL
32806-3031
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-4883
  • Fax: 407-644-3697
Mailing address:
  • Phone: 321-213-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: