Provider Demographics
NPI:1205486545
Name:MECCA, CAROL JEAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:MECCA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 SW 21ST AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0145
Mailing Address - Country:US
Mailing Address - Phone:352-804-9286
Mailing Address - Fax:
Practice Address - Street 1:5950 SW 21ST AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0145
Practice Address - Country:US
Practice Address - Phone:352-804-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106110363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9106110OtherSTATE LICENSE
FL1023098OtherNCCPA CERTIFICATION