Provider Demographics
NPI:1588288039
Name:ALEXANDER, NICOLE (PSYD, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20747 STERLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4317
Mailing Address - Country:US
Mailing Address - Phone:337-274-6861
Mailing Address - Fax:
Practice Address - Street 1:20747 STERLINGTON DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4317
Practice Address - Country:US
Practice Address - Phone:443-923-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist