Healthcare Provider Details

I. General information

NPI: 1972253540
Provider Name (Legal Business Name): ALEXA L. MAGNER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 08/04/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 OFFICE PARK BLVD SUITE 110
BRADENTON FL
34203-3443
US

IV. Provider business mailing address

5255 OFFICE PARK BLVD SUITE 110
BRADENTON FL
34203-3443
US

V. Phone/Fax

Practice location:
  • Phone: 941-755-7000
  • Fax: 941-755-7088
Mailing address:
  • Phone: 941-755-7000
  • Fax: 941-755-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME174895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: