Provider Demographics
NPI:1760905285
Name:AUSNEHMER, ALYSSA (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:AUSNEHMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12959 PALMS WEST DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4938
Mailing Address - Country:US
Mailing Address - Phone:561-753-8888
Mailing Address - Fax:561-795-5004
Practice Address - Street 1:12959 PALMS WEST DR STE 120
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4938
Practice Address - Country:US
Practice Address - Phone:561-753-8888
Practice Address - Fax:561-795-5004
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344494363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021630600Medicaid