Provider Demographics
NPI:1891798526
Name:ALEXANDER, EILEEN BROWN (ARNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:BROWN
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 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-886-4964
Practice Address - Street 1:3550 W. WATERS AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2716
Practice Address - Country:US
Practice Address - Phone:813-886-8899
Practice Address - Fax:813-886-4964
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN404342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300639500Medicaid
FLS48087Medicare UPIN
FLE0108ZMedicare PIN
FL300639500Medicaid