Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME91877 | FL |
NPI | 1023059862 |
---|---|
Provider Name | Alexandra Crossman |
First Address | Ormond Beach, FL 32175-1495 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273108800 | (05) | FL |
I29790 | (02) |