Provider Demographics
NPI:1194964635
Name:KROEFF, ALEXANDRA (PA)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:KROEFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 ROURK ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4127
Mailing Address - Country:US
Mailing Address - Phone:786-797-2999
Mailing Address - Fax:
Practice Address - Street 1:603 S KNICKERBOCKER DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1034
Practice Address - Country:US
Practice Address - Phone:408-736-0441
Practice Address - Fax:408-736-0722
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5141207N00000X, 363A00000X
FLPAT9104835363AM0700X
CAPA55567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical