Provider Demographics
NPI:1104195585
Name:MACIA, KATE IVY (PA-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:IVY
Last Name:MACIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 NW 82ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6662
Mailing Address - Country:US
Mailing Address - Phone:305-227-4263
Mailing Address - Fax:305-537-7222
Practice Address - Street 1:3650 NW 82ND AVE STE 103
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6662
Practice Address - Country:US
Practice Address - Phone:305-227-4263
Practice Address - Fax:305-537-7222
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant