Provider Demographics
NPI:1215910195
Name:ALEXANDER, DORIS JEAN WAGENMAN (ARNP)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN WAGENMAN
Last Name:ALEXANDER
Suffix:
Gender:F
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-334-1400
Mailing Address - Fax:352-334-1348
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-334-1400
Practice Address - Fax:352-334-1348
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0950692363LF0000X
FLARNP950692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301482700Medicaid
FLQ10725Medicare UPIN
FLY6619YMedicare PIN
FLY6619ZMedicare ID - Type Unspecified