Provider Demographics
NPI:1255561502
Name:LEAVITT, ALEXIS CHAPAS (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:CHAPAS
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:CHAPAS
Other - Last Name:WURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5870 HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:954-377-2925
Mailing Address - Fax:954-377-3042
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5148
Practice Address - Country:US
Practice Address - Phone:904-398-5437
Practice Address - Fax:904-398-3077
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9248660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO514ZOtherMEDICARE PTAN