Provider Demographics
NPI:1164905196
Name:PACK, ALEXANDRA GABRIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:GABRIELLE
Last Name:PACK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:8209 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3016
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:727-569-1505
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2024-03-12
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant