Provider Demographics
NPI:1639366487
Name:MCNISH, KARLA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:ANN
Last Name:MCNISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 70
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2756
Practice Address - Country:US
Practice Address - Phone:386-425-4267
Practice Address - Fax:386-258-4879
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME104198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001630900Medicaid
FL001630900Medicaid