Basic Information
| Provider Information | |||||||||
| NPI: | 1902900392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | BELINDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 997 | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342200997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9417764013 | ||||||||
| Practice Location | |||||||||
| Address1: | 12271 US HIGHWAY 301 N | ||||||||
| Address2: | |||||||||
| City: | PARRISH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342198410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417518500 | ||||||||
| FaxNumber: | 9417518503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 681668100 | 05 | FL | MEDICAID |