Provider Demographics
NPI:1760231690
Name:MAZZAFERRO, ALEXANDRA KENDRICK PLA (RPSGT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KENDRICK PLA
Last Name:MAZZAFERRO
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:KENDRICK
Other - Last Name:PLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5706 NW 55TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20548156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist