Active NPI
Kayla Maczuga, PA-C
- Physician Assistant
- Fort Myers, FL
National Provider Identifier
1891504643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9119583
- Practice address
- 3650 Colonial CT
Fort Myers, FL 33913 - Phone
- (239) 274-6070
- NPI assigned
- Jan 6, 2025
- 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 | 9119583 | FL | Primary |
Addresses
Primary practice location
3650 Colonial CT
Fort Myers, FL 33913
Mailing address
19103 Rosewood Creek Way
Tampa, FL 33647
Phone (813) 545-6283
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9119583 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1891504643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19103 ROSEWOOD CREEK WAY",
"city": "TAMPA",
"state": "FL",
"postal_code": "33647",
"telephone_number": "813-545-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3650 COLONIAL CT",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33913",
"telephone_number": "239-274-6070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACZUGA",
"first_name": "KAYLA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-06",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "9119583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.