Provider Demographics
NPI:1609582246
Name:ALEXANDER, ANGELA DANNETTE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DANNETTE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:OSTEEN
Mailing Address - State:FL
Mailing Address - Zip Code:32764-9603
Mailing Address - Country:US
Mailing Address - Phone:407-547-6101
Mailing Address - Fax:407-732-6312
Practice Address - Street 1:332 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:OSTEEN
Practice Address - State:FL
Practice Address - Zip Code:32764-9603
Practice Address - Country:US
Practice Address - Phone:407-547-6101
Practice Address - Fax:407-732-6312
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171243501172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker