MEDICARE: EVA MARIE MCNALLY

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	PA18184	TX

General Provider Information

NPI Number	:	1811641699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA MARIE MCNALLY

Provider Business Mailing Address
First Line	:	3115 FAWN RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-1601
Country	:	US
Telephone Number	:	850-630-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 W PLANO PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8372
Country	:	US
Telephone Number	:	214-750-3646
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	08/08/2024

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Directions to “ EVA MARIE MCNALLY ” Practice Location

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