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General NPI Number Information
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NPI Number | 1720250855
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Entity Type | Organization
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Legal Business Name | PHYSICIAN EXTENDERS PA
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 3005 CARING WAY STE 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5304
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Country | US
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Telephone | 941-585-9244
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512700
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City | PUNTA GORDA
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State | FL
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Zip | 33951-2700
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Country | US
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Telephone | 941-585-9244
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. VERONICA ALESSANDRO
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Credential | ARNP-C
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Telephone | 941-585-9244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP3365012
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License Number State | FL
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