Provider Demographics
NPI:1235855735
Name:CONNOLLY, ALEXIS CAROLINE (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CAROLINE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2002
Mailing Address - Country:US
Mailing Address - Phone:941-757-3521
Mailing Address - Fax:941-714-0869
Practice Address - Street 1:530 5TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2002
Practice Address - Country:US
Practice Address - Phone:941-757-3521
Practice Address - Fax:941-714-0869
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily