Healthcare Provider Details

I. General information

NPI: 1700441441
Provider Name (Legal Business Name): ALEXANDRIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 NW 25TH TER
GAINESVILLE FL
32605-2296
US

IV. Provider business mailing address

401 INTERSTATE BLVD
SARASOTA FL
34240-8996
US

V. Phone/Fax

Practice location:
  • Phone: 850-428-7840
  • Fax:
Mailing address:
  • Phone: 941-312-5027
  • Fax: 941-554-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: