=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093440950
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER ANTAR TORRES II DNP, ARNP, FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2022
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 BENNETT AVE
-----------------------------------------------------
City | BURLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83318-2676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-678-7796
-----------------------------------------------------
Fax | 208-678-7799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 794 EASTLAND DR
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-6856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-3312
-----------------------------------------------------
Fax | 208-734-5036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 56761
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------