Provider Demographics
NPI:1730575762
Name:MARTIN, ALEXANDRA LAYNE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAYNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 BRANDON PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-1622
Mailing Address - Country:US
Mailing Address - Phone:270-559-8912
Mailing Address - Fax:
Practice Address - Street 1:2700 HEALING WAY STE 100
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5453
Practice Address - Country:US
Practice Address - Phone:813-929-5341
Practice Address - Fax:813-929-5393
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65143207V00000X
FLME142900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology