Basic Information
| Provider Information | |||||||||
| NPI: | 1770015364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTO | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | MITCHELL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326076110 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 724 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326076110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2017 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | ME149237 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.