1013284173 NPI number — CELESTE ANN MACDONALD ARNP

Table of content: CELESTE ANN MACDONALD ARNP (NPI 1013284173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013284173 NPI number — CELESTE ANN MACDONALD ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
CELESTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACDONALD
Provider Other First Name:
CELESTE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013284173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 TMH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-431-6183
Provider Business Mailing Address Fax Number:
850-431-6497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 MAR WALT DRIVE
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-431-6183
Provider Business Practice Location Address Fax Number:
850-431-6497
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP3132922 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100530200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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