Provider Demographics
NPI:1225803083
Name:VENO, ALEXANDRA LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:VENO
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 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:904-880-5533
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-880-5522
Practice Address - Fax:904-880-5533
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily