MEDICARE: ALINA T ALONSO PMHNP-BC, APRN, BCBA

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	11020455	FL
2	103K00000X	Behavior Analyst	1-21-55877	FL
3	163W00000X	Registered Nurse	9224997	FL
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11020455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-21-55877	OTHER	FL	BCBA

General Provider Information

NPI Number	:	1750445391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA T ALONSO PMHNP-BC, APRN, BCBA

Provider Business Mailing Address
First Line	:	1625 SE 46TH ST STE 3B
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7435
Country	:	US
Telephone Number	:	305-978-9075
Fax Number	:	888-900-9193

Provider Business Practice Location Address
First Line	:	1625 SE 46TH ST STE 3B
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7435
Country	:	US
Telephone Number	:	305-978-9075
Fax Number	:	888-900-9193

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	03/18/2026

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