Provider Demographics
NPI:1457963605
Name:BAKOWSKI, ALEX PATRICK (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:PATRICK
Last Name:BAKOWSKI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 E WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3150
Mailing Address - Country:US
Mailing Address - Phone:708-533-2484
Mailing Address - Fax:
Practice Address - Street 1:2910 N 3RD AVE # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:602-406-6775
Practice Address - Fax:602-406-6398
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080295Medicaid