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NPI Code Detail

MEDICARE: MRS. ALEXANDRA GABRIELLE PACK PA-C

MEDICARE: MRS. ALEXANDRA GABRIELLE PACK PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9111662FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164905196
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALEXANDRA GABRIELLE PACK PA-C
Provider Business Mailing Address
First Line : 151 SOUTHHALL LN STE 300
Second Line :
City : MAITLAND
State : FL
Zip : 32751-7172
Country : US
Telephone Number : 866-400-3376
Fax Number : 407-650-3455
Provider Business Practice Location Address
First Line : 8209 STATE ROAD 54
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34655-3016
Country : US
Telephone Number : 866-400-3376
Fax Number : 727-569-1505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2018
Last Update Date : 03/12/2024

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