MEDICARE: MR. ALEXANDER JORGE FNP

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	363LF0000X	Family Nurse Practitioner	F06180471	FL

General Provider Information

NPI Number	:	1174000202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER JORGE FNP

Provider Business Mailing Address
First Line	:	4131 SW 152ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3205
Country	:	US
Telephone Number	:	305-330-4959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/24/2019

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