Provider Demographics
NPI:1831581727
Name:ALEXANDER, AVA ALLISON (PA)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:ALLISON
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 CIELO CT
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-2228
Mailing Address - Country:US
Mailing Address - Phone:716-206-9021
Mailing Address - Fax:
Practice Address - Street 1:1226 CIELO CT
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-2228
Practice Address - Country:US
Practice Address - Phone:716-206-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06092363A00000X
OH50.007854RX363A00000X
FLPA9119534363A00000X
NY029434-01363A00000X
SCTL2281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant