Healthcare Provider Details

I. General information

NPI: 1801669882
Provider Name (Legal Business Name): ALIELKIS MENDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 RACCOON RD
ZOLFO SPRINGS FL
33890-6712
US

IV. Provider business mailing address

3746 RACCOON RD
ZOLFO SPRINGS FL
33890-6712
US

V. Phone/Fax

Practice location:
  • Phone: 305-510-9076
  • Fax: 863-774-1645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: