Provider Demographics
NPI:1497877294
Name:LUPO, ALEXANDRA S (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:S
Last Name:LUPO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 N 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3321
Mailing Address - Country:US
Mailing Address - Phone:954-328-9040
Mailing Address - Fax:954-981-3832
Practice Address - Street 1:2221 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3321
Practice Address - Country:US
Practice Address - Phone:954-328-9040
Practice Address - Fax:954-981-3832
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2186171100000X
FLARNP9185949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist