Provider Demographics
NPI:1053021626
Name:NAGLE, ALEXANDRA ANNE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANNE
Last Name:NAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 QUAY ASSISI
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5103
Mailing Address - Country:US
Mailing Address - Phone:407-615-0268
Mailing Address - Fax:
Practice Address - Street 1:305 QUAY ASSISI
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5103
Practice Address - Country:US
Practice Address - Phone:407-615-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist