Provider Demographics
NPI:1649947227
Name:GORSKI ZAWADA, ALEXIS VIOLET
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:VIOLET
Last Name:GORSKI ZAWADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 TIKI LN APT 1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7166
Mailing Address - Country:US
Mailing Address - Phone:779-249-9213
Mailing Address - Fax:
Practice Address - Street 1:6801 TIKI LN APT 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7166
Practice Address - Country:US
Practice Address - Phone:779-249-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL406194376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide