Healthcare Provider Details

I. General information

NPI: 1598482713
Provider Name (Legal Business Name): ALEXIA YAVALAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MYRTLE ST
NEPTUNE BEACH FL
32266-5122
US

IV. Provider business mailing address

301 MYRTLE ST
NEPTUNE BEACH FL
32266-5122
US

V. Phone/Fax

Practice location:
  • Phone: 941-720-6137
  • Fax:
Mailing address:
  • Phone: 941-720-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: