Michael S McNulty, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA0011803L Issued in PA

Practice address

22928 Eagles Watch Dr
Land O Lakes, FL 34639-4787

Phone

(813) 929-0733

Fax

(813) 903-4812

NPI assigned

Feb 9, 2006

Reactivated

Feb 24, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1811960099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22928 EAGLES WATCH DR",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346394787",
            "telephone_number": "813-929-0733",
            "fax_number": "813-903-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22928 EAGLES WATCH DR",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346394787",
            "telephone_number": "813-929-0733",
            "fax_number": "813-903-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNULTY",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2016-02-24",
        "deactivation_date": "2016-02-01",
        "reactivation_date": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA0011803L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MA0011803L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chase McGuire
• Shirin McLaughlin
• Stacy Jo McLeod, MSN, APRN, FNP-BC
• Tamy S McMann, LMT
• Judith McMorris
• Sun O McNulty, CNA
• MCR Health, Inc.
• MCR Health, Inc.
• MCR Health, Inc.
• Amy McSherry

• Medical Physician Assistant in Land O Lakes, FL
• Providers in Land O Lakes, 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 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.