Provider Demographics
NPI:1962719492
Name:NAVARRO, ALEJANDRO (PA-C)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEJANDRO
Other - Middle Name:NAVARRO
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1875 INDIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7942
Mailing Address - Country:US
Mailing Address - Phone:904-718-5836
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:STE 140
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-461-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106492363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016532200Medicaid
FLIM430YMedicare PIN