MEDICARE: JOSIANE ALEXANDRE

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	8195	CT

General Provider Information

NPI Number	:	1699309492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIANE ALEXANDRE

Provider Business Mailing Address
First Line	:	1551 BLUE HILLS AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-1151
Country	:	US
Telephone Number	:	860-242-7834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 BLUE HILLS AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-1151
Country	:	US
Telephone Number	:	860-242-7834
Fax Number	:

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

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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