Provider Demographics
NPI:1073094462
Name:SHOEMAKER, ALEXANDRA JUDITH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JUDITH
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:2310 VILLAGE SQUARE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6351
Practice Address - Country:US
Practice Address - Phone:904-264-6404
Practice Address - Fax:904-390-7455
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant