Provider Demographics
NPI:1205415585
Name:ALEXIS, JEAN JUDE (APRN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JUDE
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 LAKE WORTH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2904
Mailing Address - Country:US
Mailing Address - Phone:613-288-4205
Mailing Address - Fax:561-828-2884
Practice Address - Street 1:6415 LAKE WORTH RD STE 207
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2904
Practice Address - Country:US
Practice Address - Phone:613-288-4205
Practice Address - Fax:561-828-2884
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11013685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11013685OtherBOARD OF NURSING