Healthcare Provider Details

I. General information

NPI: 1790032464
Provider Name (Legal Business Name): ALEXIS A HLAVACH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 COOPER CREEK BLVD STE 102
UNIVERSITY PARK FL
34201-2016
US

IV. Provider business mailing address

8430 COOPER CREEK BLVD STE 102
UNIVERSITY PARK FL
34201-2016
US

V. Phone/Fax

Practice location:
  • Phone: 941-360-2255
  • Fax: 941-487-1777
Mailing address:
  • Phone: 941-360-2255
  • Fax: 941-487-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9106648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: