MEDICARE: ALYSSA L MACCA APRN

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	363L00000X	Nurse Practitioner	ARNP9204843	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	U7175X	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01904	OTHER	FL	UNIVERSAL
2	301304	OTHER	FL	AVMED
3	200731387	OTHER	FL	TRICARE
4	37919Z	OTHER	FL	BCBS PROVIDER #
5	Y12VV	OTHER	FL	BCBS
6	200731387	OTHER	FL	HUMANA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346317047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA L MACCA APRN

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 HIGHLANDS BY THE LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-3083
Country	:	US
Telephone Number	:	863-640-8500
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/22/2021

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Directions to “ ALYSSA L MACCA APRN” Practice Location

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