Provider Demographics
NPI:1508596479
Name:ANTOS, ALEXANDRA CHRISTINE (MMS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:ANTOS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-2736
Mailing Address - Country:US
Mailing Address - Phone:607-426-8418
Mailing Address - Fax:
Practice Address - Street 1:2400 PRATT ST FL 5
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3976
Practice Address - Country:US
Practice Address - Phone:919-668-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC0010-12336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-12336OtherNC MEDICAL BOARD PA LICENSE