Provider Demographics
NPI:1326795600
Name:MARTSOLF, ALEXANDER DAVID
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAVID
Last Name:MARTSOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 SE 99TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6331
Mailing Address - Country:US
Mailing Address - Phone:352-653-5803
Mailing Address - Fax:
Practice Address - Street 1:6035 SE 99TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-6331
Practice Address - Country:US
Practice Address - Phone:352-653-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9472860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse