Provider Demographics
NPI:1669012431
Name:EXPOSITO, RENE ALCIDES (APRN)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ALCIDES
Last Name:EXPOSITO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49106
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-9106
Mailing Address - Country:US
Mailing Address - Phone:727-269-5618
Mailing Address - Fax:727-265-3420
Practice Address - Street 1:603 7TH ST S STE 520
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4734
Practice Address - Country:US
Practice Address - Phone:727-322-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7HMIFOtherBLUE CROS BLUE SHIELD
FL109483200Medicaid