Provider Demographics
NPI:1952813354
Name:COLARUSSO, ALEXANDRA BLISS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:BLISS
Last Name:COLARUSSO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:11035 GOLF LINKS DR # 79217
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8045
Mailing Address - Country:US
Mailing Address - Phone:704-247-8355
Mailing Address - Fax:
Practice Address - Street 1:7940 WILLIAMS POND LN STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8409
Practice Address - Country:US
Practice Address - Phone:704-247-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2021-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant