Individual
ALEXIS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
823 DUNLAWTON AVE, PORT ORANGE, FL 32127-4220
(352) 332-8588
Mailing address
2035 SW 75TH ST STE B, GAINESVILLE, FL 32607-3425
(352) 332-8588
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S
—
FL
Enumeration date
04/15/2018
Last updated
04/15/2018
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