Provider Demographics
NPI:1922773571
Name:PATEK, ALEXANDRA BLAIR (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:BLAIR
Last Name:PATEK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 LARRYS LN
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-4524
Mailing Address - Country:US
Mailing Address - Phone:361-772-2047
Mailing Address - Fax:
Practice Address - Street 1:405 N LAMAR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2103
Practice Address - Country:US
Practice Address - Phone:737-255-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily