Provider Demographics
NPI:1982472247
Name:SCOTT, ALEXIA BRIANNA
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:BRIANNA
Last Name:SCOTT
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 1:891 NW 250TH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0029
Mailing Address - Country:US
Mailing Address - Phone:386-438-9455
Mailing Address - Fax:
Practice Address - Street 1:4196 W US HIGHWAY 90 STE 105
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8834
Practice Address - Country:US
Practice Address - Phone:386-243-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029837363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics