Healthcare Provider Details

I. General information

NPI: 1750497541
Provider Name (Legal Business Name): JOSEPHINE MEEI MACKEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 TAMIAMI TRL N STE 100-D
NAPLES FL
34110-1614
US

IV. Provider business mailing address

4995 MILANO ST
AVE MARIA FL
34142-9545
US

V. Phone/Fax

Practice location:
  • Phone: 239-842-9199
  • Fax: 239-320-9986
Mailing address:
  • Phone: 239-842-9199
  • Fax: 239-320-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS19082
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number51605-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: