Provider Demographics
NPI:1598711913
Name:NIBE, ALEXIS (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:NIBE
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 1:2230 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1391
Mailing Address - Country:US
Mailing Address - Phone:352-237-4133
Mailing Address - Fax:352-237-7728
Practice Address - Street 1:2230 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292335100Medicaid