Provider Demographics
NPI:1063408904
Name:GAUTHIER, ALEXIS D (ARNP)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:D
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4520
Mailing Address - Country:US
Mailing Address - Phone:850-785-0515
Mailing Address - Fax:850-763-8400
Practice Address - Street 1:25 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4520
Practice Address - Country:US
Practice Address - Phone:850-785-0515
Practice Address - Fax:850-763-8400
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP827662367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034927500Medicaid