Provider Demographics
NPI:1386537165
Name:RUDOLPH, ALYSSA ANNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANNE
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10172 SW 55TH LN
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5629
Mailing Address - Country:US
Mailing Address - Phone:954-235-7759
Mailing Address - Fax:
Practice Address - Street 1:10172 SW 55TH LN
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5629
Practice Address - Country:US
Practice Address - Phone:954-235-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily