MEDICARE: MASON CARNLEY FNP-C, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1184512212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASON CARNLEY FNP-C, LLC

Provider Business Mailing Address
First Line	:	225 JERNIGAN AVE
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-4223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2168
Country	:	US
Telephone Number	:	850-215-1024
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MASON CARNLEY
Credential	:	FNP-C, APRN
Telephone Number	:	850-849-3324

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/26/2025

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