MEDICARE: MISS LINDSEY MACK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA055821	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033453253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LINDSEY MACK PA-C

Provider Business Mailing Address
First Line	:	155 S COURT AVE UNIT 2510
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3217
Country	:	US
Telephone Number	:	954-790-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 LEE RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-1746
Country	:	US
Telephone Number	:	407-629-9281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	02/19/2020

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