=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457334757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXA MILAGROS WU CHAVEZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4160 UNIVERSITY BLVD S
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-4317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-861-1900
-----------------------------------------------------
Fax | 904-292-9264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 878
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33836-0878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-223-3898
-----------------------------------------------------
Fax | 689-223-3898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 16166
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ACN960
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------