Provider Demographics
NPI:1114567948
Name:SALAS, ALEXANDRA (NURSE ANESTHETIST)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SALAS
Suffix:
Gender:F
Credentials:NURSE ANESTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5626
Mailing Address - Country:US
Mailing Address - Phone:813-922-5315
Mailing Address - Fax:
Practice Address - Street 1:28 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5626
Practice Address - Country:US
Practice Address - Phone:813-922-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144430367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered