Provider Demographics
NPI:1043802531
Name:ALEXANDER, ALISHA RYAN (APRN)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:RYAN
Last Name:ALEXANDER
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 1:3373 GOVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3839
Mailing Address - Country:US
Mailing Address - Phone:132-147-4427
Mailing Address - Fax:
Practice Address - Street 1:250 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8625
Practice Address - Country:US
Practice Address - Phone:321-752-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily