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General NPI Number Information
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NPI Number | 1033453253
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Entity Type | Individual
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Provider Name | LINDSEY MACK PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 2540 LEE RD
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City | WINTER PARK
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State | FL
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Zip | 32789-1746
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Country | US
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Telephone | 407-629-9281
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Fax |
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Provider Business Mailing Address
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Address Line | 155 S COURT AVE UNIT 2510
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City | ORLANDO
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State | FL
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Zip | 32801-3217
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Country | US
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Telephone | 954-790-4278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA055821
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License Number State | PA
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