1871536334 NPI number — MRS. MYRIAM I. ALEXANDER ARNP

Table of content: MRS. MYRIAM I. ALEXANDER ARNP (NPI 1871536334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871536334 NPI number — MRS. MYRIAM I. ALEXANDER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
MYRIAM
Provider Middle Name:
I.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLER
Provider Other First Name:
MYRIAM
Provider Other Middle Name:
ISMAELITE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871536334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SW 12TH STREET
Provider Second Line Business Mailing Address:
SUITE 201B
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-6525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-291-0019
Provider Business Mailing Address Fax Number:
352-291-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 SW 20TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-7734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-622-4251
Provider Business Practice Location Address Fax Number:
352-622-0102
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN144366 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: ARNP 9202381 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 308662300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y098C . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 308662300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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