Provider Demographics
NPI:1457054363
Name:ALEXIS, KRYSTEL CARMEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:CARMEN
Last Name:ALEXIS
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 1:950 BRICKELL BAY DR APT 3303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3956
Mailing Address - Country:US
Mailing Address - Phone:786-376-3852
Mailing Address - Fax:
Practice Address - Street 1:9111 PARK DR
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3159
Practice Address - Country:US
Practice Address - Phone:305-759-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant