Provider Demographics
NPI:1043687619
Name:DIEGO, ALEXANDRIA WEST (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:WEST
Last Name:DIEGO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743144
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3144
Mailing Address - Country:US
Mailing Address - Phone:954-837-1490
Mailing Address - Fax:954-837-1188
Practice Address - Street 1:1228 S PINE ISLAND RD STE 410
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4583
Practice Address - Country:US
Practice Address - Phone:954-837-1490
Practice Address - Fax:954-837-1188
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9262193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017959200Medicaid