Provider Demographics
NPI:1730668765
Name:MACDONALD, GREGG SCOTT (APRN)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:SCOTT
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1290
Mailing Address - Fax:239-343-4008
Practice Address - Street 1:13782 PLANTATION RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:239-343-1290
Practice Address - Fax:239-343-4008
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2021-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9325367364S00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100935200Medicaid