Basic Information
Provider Information
NPI: 1215287784
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PULFER
FirstName: ALEXIS
MiddleName: ADLEBURG
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ADLEBURG
OtherFirstName: ALEXIS
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1300 MICCOSUKEE RD
Address2:  
City: TALLAHASSEE
State: FL
PostalCode: 323085054
CountryCode: US
TelephoneNumber: 9548382588
FaxNumber: 9545143979
Practice Location
Address1: 1613 HARRISON PKWY
Address2: SUITE 200
City: SUNRISE
State: FL
PostalCode: 333232896
CountryCode: US
TelephoneNumber: 9548382588
FaxNumber: 9545143979
Other Information
ProviderEnumerationDate: 09/12/2012
LastUpdateDate: 12/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP9227566FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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