Provider Demographics
NPI:1568880151
Name:MCMAHAN, JACEY L (APRN)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:L
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 416
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1469
Mailing Address - Country:US
Mailing Address - Phone:407-303-1687
Mailing Address - Fax:407-303-1729
Practice Address - Street 1:615 E PRINCETON ST STE 416
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1469
Practice Address - Country:US
Practice Address - Phone:407-303-1687
Practice Address - Fax:407-303-1729
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner