Provider Demographics
NPI:1821547761
Name:MEYER, ALYSSA KORI (ARNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KORI
Last Name:MEYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KORI
Other - Last Name:MEDERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:175 BRISTOL FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7996
Mailing Address - Country:US
Mailing Address - Phone:321-262-4059
Mailing Address - Fax:
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9290358363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care