Provider Demographics
NPI:1205415585
Name:ALEXIS, JEAN JUDE (APRN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:JUDE
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 LAKE WORTH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2904
Mailing Address - Country:US
Mailing Address - Phone:613-288-4205
Mailing Address - Fax:561-828-2884
Practice Address - Street 1:120 BENCHLEY PL FRNT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3402
Practice Address - Country:US
Practice Address - Phone:347-843-7760
Practice Address - Fax:347-843-7780
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405853363LP0808X
FLARNP11013685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11013685OtherBOARD OF NURSING