Provider Demographics
NPI:1679613343
Name:BURWELL, ALEXANDERIA OCTAVIA (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDERIA
Middle Name:OCTAVIA
Last Name:BURWELL
Suffix:
Gender:F
Credentials:ARNP-BC
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 44008
Mailing Address - Street 2:UFJAX - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1605 N MYRTLE AVE
Practice Address - Street 2:UFJAX - UF HEALTH WELLNESS & EDUCATION CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-9618
Practice Address - Country:US
Practice Address - Phone:904-350-1197
Practice Address - Fax:904-350-9651
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2901152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3086402-00Medicaid
FLE2268SMedicare PIN
FL3086402-00Medicaid
FLE2268QMedicare PIN