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NPI Code Detail

MEDICARE: JUDITH CAROLE MCDONALD PA-C

MEDICARE: JUDITH CAROLE MCDONALD 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
1363A00000XPhysician AssistantMA002507LPA
2363AS0400XSurgical Physician AssistantMA002507LPA
3363AS0400XSurgical Physician AssistantPA9101999FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y04PHOTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932131240
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH CAROLE MCDONALD PA-C
Provider Business Mailing Address
First Line : 3125 50TH ST SW
Second Line :
City : NAPLES
State : FL
Zip : 34116
Country : US
Telephone Number : 863-661-5207
Fax Number :
Provider Business Practice Location Address
First Line : 400 CELEBRATION PL
Second Line :
City : KISSIMMEE
State : FL
Zip : 34747-4970
Country : US
Telephone Number : 407-599-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 11/14/2022

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Directions to “ JUDITH CAROLE MCDONALD PA-C” Practice Location

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