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NPI Code Detail

MEDICARE: ALEXANDRA MARIE PUCHAN PA-C

MEDICARE: ALEXANDRA MARIE PUCHAN 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 Assistant9119405FL

General Provider Information

NPI Number : 1275356586
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA MARIE PUCHAN PA-C
Provider Business Mailing Address
First Line : 17343 GULF PRESERVE DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908
Country : US
Telephone Number : 407-451-9950
Fax Number :
Provider Business Practice Location Address
First Line : 3650 COLONIAL CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-6636
Country : US
Telephone Number : 239-274-6070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2024
Last Update Date : 11/05/2024

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Directions to “ ALEXANDRA MARIE PUCHAN PA-C” Practice Location

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