Provider Demographics
NPI:1962822841
Name:LAMBERT, ALEXANDRA FASULA (ARNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:FASULA
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:FASULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5255 OFFICE PARK BLVD STE 110
Mailing Address - Street 2:BRADENTON
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3443
Mailing Address - Country:US
Mailing Address - Phone:941-755-7000
Mailing Address - Fax:941-755-7088
Practice Address - Street 1:5255 OFFICE PARK BLVD STE 110
Practice Address - Street 2:BRADENTON
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3443
Practice Address - Country:US
Practice Address - Phone:941-755-7000
Practice Address - Fax:941-755-7088
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9405347363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962822841OtherNPI
FLARNP9405347OtherNURSE PRACTITIONER LICENSE