MEDICARE: MRS. ALEXANDERIA OCTAVIA BURWELL ARNP-BC

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	ARNP2901152	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679613343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDERIA OCTAVIA BURWELL ARNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJAX - PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3199
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	1605 N MYRTLE AVE
Second Line	:	UFJAX - UF HEALTH WELLNESS & EDUCATION CENTER
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-9618
Country	:	US
Telephone Number	:	904-350-1197
Fax Number	:	904-350-9651

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	02/03/2015

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