Provider Demographics
NPI:1285691915
Name:SHUNICK, ALEXANDRA ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:SHUNICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:SYFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0680
Mailing Address - Fax:352-265-7241
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0680
Practice Address - Fax:352-265-7241
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9167055363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303329500Medicaid
FLAC288YMedicare PIN
Q77916Medicare UPIN
FL303329500Medicaid