Judy R Macnichols, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA3264 Issued in FL

Practice address

1070 N. Stone Street
Suite a
Deland, FL 32720

Phone

(386) 943-7100

Fax

(386) 738-8909

NPI assigned

Aug 12, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mrs. Judith Rubiela Macnichols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1407858004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 N STONE ST",
            "address_2": "SUITE A",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327200919",
            "telephone_number": "386-943-7100",
            "fax_number": "386-943-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 N. STONE STREET",
            "address_2": "SUITE A",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "32720",
            "telephone_number": "386-943-7100",
            "fax_number": "386-738-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACNICHOLS",
        "first_name": "JUDY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3264",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA3264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290967700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "MACNICHOLS",
            "middle_name": "RUBIELA",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lyle E Wadsworth MD PA
• Anika Lynch
• Susan Patricia Lynch, APRN
• M. Wharry, Inc.
• Morgan Macintyre, DO
• Thomas Main, PHARMD
• Susan Makinson, LCSW
• Barbara Manchec, M.D.
• Anayeli Mancilla
• David Lawrence Manco, APRN

• Medical Physician Assistant in Deland, FL
• Providers in Deland, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.