Provider Demographics
NPI:1760835110
Name:BRAVERMAN, ELEXIS LAUREN (PA)
Entity Type:Individual
Prefix:
First Name:ELEXIS
Middle Name:LAUREN
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:5017 CITY ST
Mailing Address - Street 2:APT 1915
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-4522
Mailing Address - Country:US
Mailing Address - Phone:717-917-7446
Mailing Address - Fax:
Practice Address - Street 1:500 WINDERLEY PL
Practice Address - Street 2:SUITE 115
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7247
Practice Address - Country:US
Practice Address - Phone:407-875-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant