MEDICARE: ALTEGRA HEALTH CONNECTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1104231810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTEGRA HEALTH CONNECTIONS, LLC

Provider Business Mailing Address
First Line	:	1725 N COMMERCE PKWY
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3201
Country	:	US
Telephone Number	:	305-779-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3448
Country	:	US
Telephone Number	:	305-779-6070
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MICHELE HAAS
Credential	:
Telephone Number	:	505-340-5555

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	09/22/2015

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