Individual
JUDITH CAROLE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 CELEBRATION PL, KISSIMMEE, FL 34747-4970
(407) 599-2700
Mailing address
3125 50TH ST SW, NAPLES, FL 34116
(863) 661-5207
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA002507L
PA
363AS0400X
Surgical Physician Assistant
MA002507L
PA
363AS0400X
Surgical Physician Assistant
Primary
PA9101999
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102182500
—
FL
01
—
Y04PH
BCBS
FL
Enumeration date
07/07/2006
Last updated
11/14/2022
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