MEDICARE: MRS. CARLY MARIE ACKERMAN 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	PA9116252	FL

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	:	1790259075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLY MARIE ACKERMAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 198441
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8441
Country	:	US
Telephone Number	:	813-745-7365
Fax Number	:	813-449-8618

Provider Business Practice Location Address
First Line	:	10920 MCKINLEY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6471
Country	:	US
Telephone Number	:	888-663-3488
Fax Number	:

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

Provider Enumeration Date	:	01/19/2019
Last Update Date	:	12/09/2025

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