Provider Demographics
NPI:1033308028
Name:MCNAB, PATRICIA M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:MCNAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BARTOW RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5852
Mailing Address - Country:US
Mailing Address - Phone:863-683-7171
Mailing Address - Fax:
Practice Address - Street 1:1125 BARTOW RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5852
Practice Address - Country:US
Practice Address - Phone:863-683-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111593207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008867800Medicaid
FL008867800Medicaid