MEDICARE: MRS. ALISSA GWEN LEDGERWOOD ARNP

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	ARNP9251745	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

General Provider Information

NPI Number	:	1770971343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISSA GWEN LEDGERWOOD ARNP

Provider Business Mailing Address
First Line	:	3160 SOUTHGATE COMMERCE BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-8549
Country	:	US
Telephone Number	:	407-859-4540
Fax Number	:	407-859-3815

Provider Business Practice Location Address
First Line	:	1646 33RD ST
Second Line	:	SUITE 101
City	:	ORLANDO
State	:	FL
Zip	:	32839-8866
Country	:	US
Telephone Number	:	407-409-8118
Fax Number	:	407-264-6562

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	05/08/2017

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