Provider Demographics
NPI:1942728787
Name:MILLER, ALEXANDRA DARE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DARE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:DARE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6914 TILLET CT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-5823
Mailing Address - Country:US
Mailing Address - Phone:361-443-3430
Mailing Address - Fax:
Practice Address - Street 1:14041 NORTHWEST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5138
Practice Address - Country:US
Practice Address - Phone:361-767-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily