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NPI Code Detail

MEDICARE: MRS. JACKLYN ALEXIS XAVIER P.A-C

MEDICARE: MRS. JACKLYN ALEXIS XAVIER P.A-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
1363AM0700XMedical Physician AssistantPA9107442FL

General Provider Information

NPI Number : 1396172409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACKLYN ALEXIS XAVIER P.A-C
Provider Business Mailing Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-269-6530
Fax Number : 321-269-2334
Provider Business Practice Location Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-269-6530
Fax Number : 321-269-2334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2013
Last Update Date : 06/18/2020

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