Provider Demographics
NPI:1568822435
Name:BORSBOOM, ALEXANDRA CODIE (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:CODIE
Last Name:BORSBOOM
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 FM 1488 RD STE A
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1527
Mailing Address - Country:US
Mailing Address - Phone:281-356-1945
Mailing Address - Fax:281-356-1978
Practice Address - Street 1:6912 FM 1488 RD STE A
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1527
Practice Address - Country:US
Practice Address - Phone:281-356-1945
Practice Address - Fax:281-356-1978
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130496363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology