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NPI Code Detail

MEDICARE: ALEXIS MALLON PA-C

MEDICARE: ALEXIS MALLON 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 AssistantPA9121191FL

General Provider Information

NPI Number : 1366336133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS MALLON PA-C
Provider Business Mailing Address
First Line : 8702 HUNTERS LAKE DR STE 100
Second Line :
City : TAMPA
State : FL
Zip : 33647-2855
Country : US
Telephone Number : 813-467-4700
Fax Number :
Provider Business Practice Location Address
First Line : 8702 HUNTERS LAKE DR STE 100
Second Line :
City : TAMPA
State : FL
Zip : 33647-2855
Country : US
Telephone Number : 813-467-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2025
Last Update Date : 01/26/2026

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1417353665 — KELLY MARIE BOLIN APRN
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Directions to “ ALEXIS MALLON PA-C” Practice Location

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