Healthcare Provider Details

I. General information

NPI: 1962719492
Provider Name (Legal Business Name): ALEJANDRO NAVARRO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEJANDRO NAVARRO VALENZUELA

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 140
ST AUGUSTINE FL
32080-3108
US

IV. Provider business mailing address

1875 INDIAN RIVER DR
FLEMING ISLAND FL
32003-7942
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-6060
  • Fax:
Mailing address:
  • Phone: 904-718-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106492
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: