MEDICARE: ALEXANDER GINWRIGHT

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	172V00000X	Community Health Worker	OTA11458	FL

General Provider Information

NPI Number	:	1699049189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER GINWRIGHT

Provider Business Mailing Address
First Line	:	1912 SADIA RD
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-3769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 SANDIA RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5739
Country	:	US
Telephone Number	:	408-835-6974
Fax Number	:

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

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	10/12/2012

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Directions to “ ALEXANDER GINWRIGHT ” Practice Location

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