Provider Demographics
NPI:1891590782
Name:BUSH, ALEXANDRA (PMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W BREVARD ST APT 122
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-7754
Mailing Address - Country:US
Mailing Address - Phone:813-508-5394
Mailing Address - Fax:
Practice Address - Street 1:990 W BREVARD ST APT 122
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-7754
Practice Address - Country:US
Practice Address - Phone:813-508-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL530938146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic