Macnichols, Judy R

Macnichols, Judy R is an individual health care provider with primary practice located at 1070 N. Stone Street Suite A, Deland FL 32720. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Macnichols, Judy R can be contacted via phone (386) 943-7100.

Contact Information

Primary practice address
1070 N. Stone Street Suite A Deland FL 32720
Phone: (386) 943-7100
Fax: (386) 738-8909
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA3264 Florida
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA3264 Florida

Profile Details

NPI number 1407858004
LBN Legal business name Macnichols, Judy R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Feb 19th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407858004 NPPES
Florida MEDICAID 290967700

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