Healthcare Provider Details

I. General information

NPI: 1174125520
Provider Name (Legal Business Name): ALEXIS BORGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS TANAS

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N HALLECK ST
DEMOTTE IN
46310-9419
US

IV. Provider business mailing address

1805 CALUMET AVE
VALPARAISO IN
46383-3130
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 219-464-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010772A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28198542A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: