Provider Demographics
NPI:1851357040
Name:ISAACS, ALEXIS GAZAK (NNP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GAZAK
Last Name:ISAACS
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E MISSOURI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:786-780-9298
Mailing Address - Fax:954-618-4153
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-30
Deactivation Date:2022-11-01
Deactivation Code:
Reactivation Date:2023-03-24
Provider Licenses
StateLicense IDTaxonomies
AZAP11523363LN0005X
CORN.1656760363LN0005X, 363LN0005X
COAPN.0995836-NP363LN0005X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care