Healthcare Provider Details

I. General information

NPI: 1508439647
Provider Name (Legal Business Name): SARA E ALEXANDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GRAY AVE
WILDWOOD FL
34785-3520
US

IV. Provider business mailing address

601 GRAY AVE
WILDWOOD FL
34785-3520
US

V. Phone/Fax

Practice location:
  • Phone: 352-808-2666
  • Fax:
Mailing address:
  • Phone: 352-808-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: