Healthcare Provider Details

I. General information

NPI: 1225659105
Provider Name (Legal Business Name): EMILY E MASTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 SW MICHIGAN ST
LAKE CITY FL
32025-0440
US

IV. Provider business mailing address

439 SW MICHIGAN ST
LAKE CITY FL
32025-0440
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-0800
  • Fax:
Mailing address:
  • Phone: 386-487-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: