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General NPI Number Information
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NPI Number | 1063506681
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Entity Type | Individual
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Provider Name | MARK ANTHONY PAYNE PAC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 750 CENTERVIEW BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34741-7651
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Country | US
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Telephone | 407-850-3497
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Fax | 904-697-5102
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Provider Business Mailing Address
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Address Line | 10140 CENTURION PKWY N
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0532
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Country | US
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Telephone | 904-697-4100
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Fax | 904-697-5102
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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 | PA 2752
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License Number State | FL
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