Provider Demographics
NPI:1154106136
Name:GILLESPIE, ALEXANDRA (CRNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CRESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1737
Mailing Address - Country:US
Mailing Address - Phone:484-326-4210
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 620
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3719
Practice Address - Country:US
Practice Address - Phone:215-885-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily