MEDICARE: MASON DOUGLAS CARNLEY APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11040161	FL

General Provider Information

NPI Number	:	1770479131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON DOUGLAS CARNLEY APRN, FNP-C

Provider Business Mailing Address
First Line	:	2318 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2168
Country	:	US
Telephone Number	:	850-215-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2168
Country	:	US
Telephone Number	:	850-215-1024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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