Provider Demographics
NPI:1265665244
Name:PRICE, ALEXANDRA N (DNP, FNP-BC/PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:N
Last Name:PRICE
Suffix:
Gender:F
Credentials:DNP, FNP-BC/PMHNP-BC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:N
Other - Last Name:FERNANDEZ PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC/PMHNP-BC
Mailing Address - Street 1:855 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-5408
Mailing Address - Country:US
Mailing Address - Phone:860-793-3500
Mailing Address - Fax:
Practice Address - Street 1:855 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-5408
Practice Address - Country:US
Practice Address - Phone:860-793-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7296363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235900Medicaid