Provider Demographics
NPI:1023092913
Name:SOCKWELL, ALEXIS TAQWAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:TAQWAN
Last Name:SOCKWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50922
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0307
Mailing Address - Country:US
Mailing Address - Phone:941-914-6610
Mailing Address - Fax:941-866-8121
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:STE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6014
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:941-366-8043
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101772363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6267XMedicare ID - Type Unspecified