Provider Demographics
NPI:1932131240
Name:MCDONALD, JUDITH CAROLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAROLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:C
Other - Last Name:SNAVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3125 50TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116
Mailing Address - Country:US
Mailing Address - Phone:863-661-5207
Mailing Address - Fax:
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-599-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002507L363A00000X, 363AS0400X
FLPA9101999363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102182500Medicaid
FLY04PHOtherBCBS
FL1144228446OtherCORPORATE NPI-LRMC
FLP00292570Medicare PIN
FLE7362OtherBCBS
FLP61878Medicare UPIN
FL291291100Medicaid
FL1497748743OtherCORPORATE NPI-LRHSI
FLE7362TMedicare PIN
FLE7362XMedicare PIN
FLE7362VMedicare PIN
FLE7362WMedicare PIN