Provider Demographics
NPI:1952029092
Name:ACEVEDO, ALEXANDER JOSEPH (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S OAKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4229
Mailing Address - Country:US
Mailing Address - Phone:773-742-0698
Mailing Address - Fax:
Practice Address - Street 1:120 KAIULANI AVE LBBY 11
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-6203
Practice Address - Country:US
Practice Address - Phone:808-922-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily