Provider Demographics
NPI:1831704089
Name:MACKLIN, ALEXIS MARGARET (CRNP)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:MARGARET
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:305 GEORGETOWNE CT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8660
Mailing Address - Country:US
Mailing Address - Phone:724-630-5278
Mailing Address - Fax:
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022357363LF0000X
FLAPRN11021577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily