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General NPI Number Information
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NPI Number | 1558586388
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Entity Type | Individual
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Provider Name | PATRICE C MACK MD, PA
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 801 LAUREL OAK DR STE 715
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City | NAPLES
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State | FL
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Zip | 34108
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Country | US
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Telephone | 239-254-0535
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Fax | 239-254-0532
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Provider Business Mailing Address
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Address Line | 801 LAUREL OAK DR STE 715
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City | NAPLES
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State | FL
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Zip | 34108-2754
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Country | US
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Telephone | 239-254-0535
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Fax | 239-254-0532
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME24010
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME24010
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License Number State | FL
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