Provider Demographics
NPI:1477320059
Name:MASSIE, LEE ADAM (ACACNP-BC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ADAM
Last Name:MASSIE
Suffix:
Gender:M
Credentials:ACACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 HOLLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6883
Mailing Address - Country:US
Mailing Address - Phone:904-622-8618
Mailing Address - Fax:
Practice Address - Street 1:1795 HOLLOW GLEN DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6883
Practice Address - Country:US
Practice Address - Phone:904-622-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030005363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care