Provider Demographics
NPI:1073396214
Name:ALLEN, ALEXANDRA AYNSLEY
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:AYNSLEY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4057
Mailing Address - Country:US
Mailing Address - Phone:850-686-4518
Mailing Address - Fax:
Practice Address - Street 1:5721 USA DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-445-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program