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General NPI Number Information
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NPI Number | 1750497541
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Entity Type | Individual
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Provider Name | JOSEPHINE MEEI MACKEN DO
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 12810 TAMIAMI TRL N STE 100-D
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City | NAPLES
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State | FL
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Zip | 34110-1614
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Country | US
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Telephone | 239-842-9199
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Fax | 239-320-9986
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Provider Business Mailing Address
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Address Line | 4995 MILANO ST
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City | AVE MARIA
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State | FL
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Zip | 34142-9545
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Country | US
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Telephone | 239-842-9199
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Fax | 239-320-9986
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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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS19082
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 51605-21
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License Number State | WI
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