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NPI Code Detail

MEDICARE: ALEXANDRA WAGNER

MEDICARE: ALEXANDRA WAGNER
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
1247200000XOther TechnicianFL

General Provider Information

NPI Number : 1871952390
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA WAGNER
Provider Business Mailing Address
First Line : 8450 CHERINOYA CT
Second Line :
City : ORLANDO
State : FL
Zip : 32825-3605
Country : US
Telephone Number : 727-510-6012
Fax Number :
Provider Business Practice Location Address
First Line : 3730 GATLIN WOODS DR
Second Line :
City : ORLANDO
State : FL
Zip : 32812-7610
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2016
Last Update Date : 02/11/2016

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Directions to “ ALEXANDRA WAGNER ” Practice Location

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