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Individual

ALEXANDER MAZEKINA TAIRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
300 NW 70TH AVE STE 205, PLANTATION, FL 33317-2367
(954) 321-5428
(954) 583-0660
Mailing address
300 NW 70TH AVE STE 205, PLANTATION, FL 33317-2367
(954) 321-5428
(954) 583-0660

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP 9385407
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
APRN9385407
APRN
FL
Enumeration date
01/18/2016
Last updated
09/05/2019
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