Provider Demographics
NPI:1972253540
Name:MAGNER, ALEXA L (MD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:L
Last Name:MAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5255 OFFICE PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3443
Mailing Address - Country:US
Mailing Address - Phone:941-755-7000
Mailing Address - Fax:941-755-7088
Practice Address - Street 1:5255 OFFICE PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3443
Practice Address - Country:US
Practice Address - Phone:941-755-7000
Practice Address - Fax:941-755-7088
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME174895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL127327700Medicaid