Healthcare Provider Details

I. General information

NPI: 1750293890
Provider Name (Legal Business Name): ALEXANDRA MARIE CHALMERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 LAKEWALK DR # 1301
WINTER GARDEN FL
34787-5728
US

IV. Provider business mailing address

5006 LAKEWALK DR # 1301
WINTER GARDEN FL
34787-5728
US

V. Phone/Fax

Practice location:
  • Phone: 215-779-2389
  • Fax:
Mailing address:
  • Phone: 215-779-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: