Provider Demographics
NPI:1548991185
Name:MEMOLI, ALYSA ROSE (DNP, APRN)
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:ROSE
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9710
Mailing Address - Fax:239-343-4178
Practice Address - Street 1:9981 S HEALTHPARK DR STE 454
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-9710
Practice Address - Fax:239-343-4178
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9424850163W00000X
FLAPRN11020427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114667300Medicaid