Provider Demographics
NPI:1285385088
Name:BRECKENRIDGE, ALEC R (PA-C)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:R
Last Name:BRECKENRIDGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4365
Mailing Address - Country:US
Mailing Address - Phone:734-740-8901
Mailing Address - Fax:
Practice Address - Street 1:10489 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-489-2486
Practice Address - Fax:352-489-5786
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical