Provider Demographics
NPI:1790032464
Name:HLAVACH, ALEXIS A (PA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:HLAVACH
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 1:8430 COOPER CREEK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2016
Mailing Address - Country:US
Mailing Address - Phone:941-360-2255
Mailing Address - Fax:941-487-1777
Practice Address - Street 1:8430 COOPER CREEK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2016
Practice Address - Country:US
Practice Address - Phone:941-360-2255
Practice Address - Fax:941-487-1777
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106648207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty