Provider Demographics
NPI:1770675969
Name:LOCKLEAR, ALEXANDRA MACKINLAY (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MACKINLAY
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 BERRYHILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1013
Mailing Address - Country:US
Mailing Address - Phone:850-623-9787
Mailing Address - Fax:
Practice Address - Street 1:5992 BERRYHILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1013
Practice Address - Country:US
Practice Address - Phone:850-623-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant