Basic Information
| Provider Information | |||||||||
| NPI: | 1457699324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDIS | ||||||||
| FirstName: | ALTIA | ||||||||
| MiddleName: | ALJEANA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 W SAMPLE RD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173750524 | ||||||||
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| Practice Location | |||||||||
| Address1: | 806 S DOUGLAS RD | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331343157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054474150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9291957 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.