Healthcare Provider Details

I. General information

NPI: 1851374334
Provider Name (Legal Business Name): PACE OBSTETRICS AND GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4628 SUMMERDALE DR
PACE FL
32571-1368
US

IV. Provider business mailing address

4628 SUMMERDALE DR
PACE FL
32571-1368
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-9066
  • Fax: 850-995-9074
Mailing address:
  • Phone: 850-995-9066
  • Fax: 850-995-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LARISSA DAWN MCCARTHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-995-9066