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NPI Code Detail

MEDICARE: JACEY L MCMAHAN APRN

MEDICARE: JACEY L MCMAHAN 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
1363L00000XNurse PractitionerARNP9308605FL

Other Identifiers

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

General Provider Information

NPI Number : 1568880151
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACEY L MCMAHAN APRN
Provider Business Mailing Address
First Line : 615 E PRINCETON ST STE 416
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1469
Country : US
Telephone Number : 407-303-1687
Fax Number : 407-303-1729
Provider Business Practice Location Address
First Line : 615 E PRINCETON ST STE 416
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1469
Country : US
Telephone Number : 407-303-1687
Fax Number : 407-303-1729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 08/03/2021

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Directions to “ JACEY L MCMAHAN APRN” Practice Location

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