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General NPI Number Information
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NPI Number | 1639814577
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Entity Type | Individual
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Provider Name | RAVEN ALEXYS COE MPAS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 4018 HIGHVIEW RD
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City | SEFFNER
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State | FL
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Zip | 33584-5202
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Country | US
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Telephone | 813-651-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 222 SW LINCOLN CIR N
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City | ST PETERSBURG
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State | FL
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Zip | 33703-1311
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Country | US
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Telephone | 954-599-5379
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAT9115879
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License Number State | FL
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