Active NPI
Nathaniel David Mack, PA-C
- Physician Assistant
- Panama City, FL
National Provider Identifier
1285296137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1285296137
- Practice address
- 340 Magnolia Cir BLDG 1465
Panama City, FL 32403-5604 - Phone
- (850) 283-7576
- NPI assigned
- Jul 1, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1285296137 | Primary | |
| Military Health Care Provider | 171000000X | 1285296137 |
Addresses
Primary practice location
340 Magnolia Cir BLDG 1465
Panama City, FL 32403-5604
Mailing address
340 Magnolia Circile, BLDG. 1465
Panama City, FL 32403-5604
Phone (850) 286-7576
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1285296137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 MAGNOLIA CIRCILE, BLDG. 1465",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "850-286-7576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 MAGNOLIA CIR BLDG 1465",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "850-283-7576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "NATHANIEL",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-01",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "1285296137",
"primary": true
},
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": "1285296137",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.