Healthcare Provider Details

I. General information

NPI: 1386268431
Provider Name (Legal Business Name): ALEXANDRA CHRISTINA CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD RM 6130
GAINESVILLE FL
32610-6922
US

IV. Provider business mailing address

4925 LAKE GATLIN WOODS CT
ORLANDO FL
32806-6922
US

V. Phone/Fax

Practice location:
  • Phone: 407-454-4396
  • Fax:
Mailing address:
  • Phone: 407-454-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9113313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: