Provider Demographics
NPI:1144951492
Name:DEFRANCE, ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:DEFRANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5198
Mailing Address - Country:US
Mailing Address - Phone:860-301-9935
Mailing Address - Fax:
Practice Address - Street 1:59 SYCAMORE ST STE 301
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4536
Practice Address - Country:US
Practice Address - Phone:860-430-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030662363AS0400X
NJ25MP00807400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical