=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972155109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAILYS ALFRED APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2019
-----------------------------------------------------
Last Update Date | 02/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 N STATE ROAD 7 STE E
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-798-6600
-----------------------------------------------------
Fax | 561-753-3328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10131 FOREST HILL BLVD STE 230
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-798-6600
-----------------------------------------------------
Fax | 561-753-3328
-----------------------------------------------------
=====================================================
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 | APRN11002854
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11002854
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------