Provider Demographics
NPI:1538714753
Name:CARTER, ALEXANDRA LEWIS
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEWIS
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALEXANDRA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100183
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0183
Mailing Address - Country:US
Mailing Address - Phone:352-392-0140
Mailing Address - Fax:352-392-8217
Practice Address - Street 1:2100 NW 35TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-4630
Practice Address - Country:US
Practice Address - Phone:352-280-7400
Practice Address - Fax:352-820-7401
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1008912084P0800X
DCMD2100116942084P0800X
390200000X
FLME1687472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124290100Medicaid