Provider Demographics
NPI:1235452285
Name:KANE, ALEXIS (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:CONCIATORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:851 TRAFALGAR COURT
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-667-0444
Mailing Address - Fax:407-667-4338
Practice Address - Street 1:1350 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3203
Practice Address - Country:US
Practice Address - Phone:904-376-4182
Practice Address - Fax:866-665-2702
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9231588367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002110500Medicaid
FLDB741YOtherMEDICARE PTAN
FLG009WOtherBCBS