Provider Demographics
NPI:1568181543
Name:BORODIAK, ALEXA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLE
Last Name:BORODIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 NW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-5039
Mailing Address - Country:US
Mailing Address - Phone:954-821-7182
Mailing Address - Fax:
Practice Address - Street 1:6032 NW 83RD TER
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-5039
Practice Address - Country:US
Practice Address - Phone:954-821-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115536363A00000X
PAMA063667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant