Provider Demographics
NPI:1477320059
Name:MASSIE, LEE ADAM (ACACNP-BC)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ADAM
Last Name:MASSIE
Suffix:
Gender:M
Credentials:ACACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:4565 US HIGHWAY 17 STE 200
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4823
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11030005363LA2100X
FLAPRN11030005363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care