Provider Demographics
NPI:1518723949
Name:SUMMERLIN, ALEXIS BRAE (RN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRAE
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:BRAE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16888 ROYAL POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1575
Mailing Address - Country:US
Mailing Address - Phone:954-899-1077
Mailing Address - Fax:
Practice Address - Street 1:4200 6TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1042
Practice Address - Country:US
Practice Address - Phone:360-459-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9469018364SH0200X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health