Provider Demographics
NPI:1245881200
Name:RAHMAN, ALEXIS DANIELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:RAHMAN
Suffix:
Gender:F
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 1:3810 NORTHDALE BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:863-397-8385
Mailing Address - Fax:
Practice Address - Street 1:3527 TABERNACLE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5834
Practice Address - Country:US
Practice Address - Phone:863-397-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9112570OtherFLORIDA PHYSICIAN ASSISTANT LICENSE