Provider Demographics
NPI:1083673412
Name:BAHADORI, ALEX B (DNP, ARNP)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:B
Last Name:BAHADORI
Suffix:
Gender:M
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10036 WHISPER RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6532
Mailing Address - Country:US
Mailing Address - Phone:352-684-6578
Mailing Address - Fax:
Practice Address - Street 1:10036 WHISPER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6532
Practice Address - Country:US
Practice Address - Phone:352-556-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3287252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102703600Medicaid
FLU1504Medicare PIN
FLQ00660Medicare UPIN