MEDICARE: AVA ALLISON ALEXANDER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-06092	NC
2	363A00000X	Physician Assistant	50.007854RX	OH
3	363A00000X	Physician Assistant	PA9119534	FL
4	363A00000X	Physician Assistant	029434-01	NY
5	363A00000X	Physician Assistant	TL2281	SC

General Provider Information

NPI Number	:	1831581727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA ALLISON ALEXANDER PA

Provider Business Mailing Address
First Line	:	1226 CIELO CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-2228
Country	:	US
Telephone Number	:	716-206-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 CIELO CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-2228
Country	:	US
Telephone Number	:	716-206-9021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	02/27/2025

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