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General NPI Number Information
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NPI Number | 1396289005
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Entity Type | Individual
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Provider Name | CODI CRAIG PAC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1926 ALCOA HWY STE F210
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City | KNOXVILLE
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State | TN
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Zip | 37920-1545
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Country | US
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Telephone | 865-305-2495
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Fax | 865-305-2496
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Provider Business Mailing Address
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Address Line | 1713 US HIGHWAY 441 N SUITE H
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City | OKEECHOBEE
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State | FL
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Zip | 34972-1900
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Country | US
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Telephone | 863-357-1510
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Fax | 863-357-1518
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA0000003122
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License Number State | TN
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