Active NPI
Megan Antinone, PA-C
- Physician Assistant
- Fort Walton Beach, FL
National Provider Identifier
1033665690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708 - Phone
- (850) 863-7607
- NPI assigned
- Sep 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Mailing address
4054 Bond Cir
Niceville, FL 32578-1629
Phone (610) 248-4729
Other names 1
- Megan Jolley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502150400000",
"number": "1033665690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4054 BOND CIR",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325781629",
"telephone_number": "610-248-4729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 MAR WALT DR",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325476708",
"telephone_number": "850-863-7607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTINONE",
"first_name": "MEGAN",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2017-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MEGAN",
"last_name": "JOLLEY",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.