Provider Demographics
NPI:1811311947
Name:ALEXANDRE, THERAL (ARNP)
Entity type:Individual
Prefix:
First Name:THERAL
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 VICTORIA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3884
Mailing Address - Country:US
Mailing Address - Phone:239-332-9568
Mailing Address - Fax:239-332-9508
Practice Address - Street 1:2295 VICTORIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3884
Practice Address - Country:US
Practice Address - Phone:239-332-9568
Practice Address - Fax:239-332-9508
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9317463163W00000X
FL9317463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9317463OtherFLORIDA HEALTH DEPARTMENT