Healthcare Provider Details

I. General information

NPI: 1003626110
Provider Name (Legal Business Name): ALEXIS CREWS SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

6216 GONDOLA DR
RIVERVIEW FL
33578-1304
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7030
  • Fax: 813-615-8350
Mailing address:
  • Phone: 813-516-3873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number20-311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: