Provider Demographics
NPI:1851312565
Name:MCKINNEY, JANE P (PAC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:P
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:P
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 357730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7730
Mailing Address - Country:US
Mailing Address - Phone:352-371-7546
Mailing Address - Fax:352-335-7546
Practice Address - Street 1:3700 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-371-7546
Practice Address - Fax:352-335-7546
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC1427OtherRAILROAD MEDICARE GROUP#
FLP00343361OtherRAILROAD MEDICARE PIN
FLK4800Medicare ID - Type UnspecifiedGROUP ID
FLDC1427OtherRAILROAD MEDICARE GROUP#
FLP00343361OtherRAILROAD MEDICARE PIN