Provider Demographics
NPI:1942850409
Name:PUTZEL, ALYSSA RAE (APRN)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:RAE
Last Name:PUTZEL
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 1:5405 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1044
Mailing Address - Country:US
Mailing Address - Phone:275-478-4257
Mailing Address - Fax:
Practice Address - Street 1:5405 PARK ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1044
Practice Address - Country:US
Practice Address - Phone:727-547-8425
Practice Address - Fax:813-635-2699
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily