Provider Demographics
NPI:1245731751
Name:RENELUS, ALEXANDRA JUDY
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JUDY
Last Name:RENELUS
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 1:2030 NEW RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1042
Mailing Address - Country:US
Mailing Address - Phone:609-445-4926
Mailing Address - Fax:855-880-6851
Practice Address - Street 1:2030 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1042
Practice Address - Country:US
Practice Address - Phone:609-445-4926
Practice Address - Fax:855-880-6851
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9386507163W00000X
FLAPRN9386507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse