Provider Demographics
NPI:1770135089
Name:TYMKOWICZ, ALEXANDRIA (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:TYMKOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2106
Mailing Address - Country:US
Mailing Address - Phone:712-251-7445
Mailing Address - Fax:407-237-6313
Practice Address - Street 1:2627 W EAU GALLIE BLVD STE 1018307
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8304
Practice Address - Country:US
Practice Address - Phone:321-837-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156308207P00000X
FLTRN28955390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine