=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508819897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARC A ALESSANDRONI PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 10/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13235 STATE ROAD 52 STE 102
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34669-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-378-8503
-----------------------------------------------------
Fax | 727-857-7807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 PINEHURST DR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-3833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5305
-----------------------------------------------------
Fax | 352-616-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9103686
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------