Provider Demographics
NPI:1669021101
Name:TRUEHEART, BRINKLEY ALEXIS
Entity Type:Individual
Prefix:MISS
First Name:BRINKLEY
Middle Name:ALEXIS
Last Name:TRUEHEART
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 1:400 AVENUE K SE STE 11
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4145
Mailing Address - Country:US
Mailing Address - Phone:863-594-4404
Mailing Address - Fax:863-294-4494
Practice Address - Street 1:400 AVENUE K SE STE 11
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4145
Practice Address - Country:US
Practice Address - Phone:863-294-4404
Practice Address - Fax:863-294-1059
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112516363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110368900Medicaid