1023092913 NPI number — MR. ALEXIS TAQWAN SOCKWELL PA-C

Table of content: MR. ALEXIS TAQWAN SOCKWELL PA-C (NPI 1023092913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023092913 NPI number — MR. ALEXIS TAQWAN SOCKWELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOCKWELL
Provider First Name:
ALEXIS
Provider Middle Name:
TAQWAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023092913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50922
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34232-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-914-6610
Provider Business Mailing Address Fax Number:
941-866-8121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6050 CATTLERIDGE BLVD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-0655
Provider Business Practice Location Address Fax Number:
941-366-8043
Provider Enumeration Date:
12/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA9101772 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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