Provider Demographics
NPI:1083190292
Name:ATANES, ALEXANDER ADON
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:ADON
Last Name:ATANES
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 1:7840 DOWD DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5911
Mailing Address - Country:US
Mailing Address - Phone:813-481-9504
Mailing Address - Fax:
Practice Address - Street 1:7840 DOWD DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-5911
Practice Address - Country:US
Practice Address - Phone:813-481-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100896700Medicaid