Provider Demographics
NPI:1982975454
Name:MINCER, ALEXIS BROOKE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BROOKE
Last Name:MINCER
Suffix:
Gender:F
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 1:1390 REVELATION RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1022
Mailing Address - Country:US
Mailing Address - Phone:610-203-3387
Mailing Address - Fax:
Practice Address - Street 1:9908 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-464-2902
Practice Address - Fax:215-464-2954
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056041363AM0700X
PAOA006847363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563996YEBKMedicare PIN
PA563996YUNMMedicare PIN