Provider Demographics
NPI:1063817732
Name:ALEXA, JUDE ADLER
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:ADLER
Last Name:ALEXA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1312
Mailing Address - Country:US
Mailing Address - Phone:727-564-1160
Mailing Address - Fax:
Practice Address - Street 1:6704 N 24TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1312
Practice Address - Country:US
Practice Address - Phone:727-564-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA420421653880343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)