MEDICARE: JANE C MAST P.A.-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	PA9102022	FL

General Provider Information

NPI Number	:	1568483337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE C MAST P.A.-C

Provider Business Mailing Address
First Line	:	695 CONE PARK CT
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3755
Country	:	US
Telephone Number	:	321-453-3360
Fax Number	:	321-453-4586

Provider Business Practice Location Address
First Line	:	695 CONE PARK CT
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3755
Country	:	US
Telephone Number	:	321-453-3360
Fax Number	:	321-453-4586

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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