KERI MACK (NPI# 1578913992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578913992 |
| Entity Type | Individual |
| Full Name | KERI MACK |
| Credential | PA-C |
| Practice Address |
7451 Gladiolus Dr Fort Myers FL 33908 |
| Mailing Address |
2160 Colonial Blvd Fort Myers FL 33907-1410 |
| Practice Telephone | 2396898800 |
| Practice Fax Number | 2397905471 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2019-08-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9109378 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3210 Cleveland Ave Ste 100, Fort Myers, FL 339017182 | 2399366778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205120912 | Keri A Mack | Speech-Language Pathologist | 5419 Bridlewood Ln, Hamburg, NY 14075-3659 | 2011-05-31 |
| 1861922833 | Keri Marie Mack | Behavioral Analyst | 44670 Ann Arbor Rd W Ste 130, Plymouth, MI 48170-4085 | 2017-06-13 |
| Street Address |
7451 GLADIOLUS DR |
| City | FORT MYERS |
| State | FL |
| Zip Code | 33908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538185939 | Veronique Fernandez-salvador | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-07-15 |
| 1336642545 | 21st Century Oncolgy LLC | Surgery | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2018-03-14 |
| 1609383942 | Anna Dunn | Physician Assistant | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2018-01-09 |
| 1376752501 | 21st Century Oncology LLC | Durable Medical Equipment & Medical Supplies | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2007-05-22 |
| 1114076171 | Genesiscare Usa of Florida LLC | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2007-01-09 |
| 1851483713 | Brian N Schwartz | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-09-29 |
| 1952493280 | Florida Urology Physicians | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-09-28 |
| 1861583197 | Ira A Zucker | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-09-28 |
| 1598857864 | Steven A Harrison | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-09-28 |
| 1043302383 | Barry F Blitz | Urology | 7451 Gladiolus Dr, Fort Myers, FL 33908-5193 | 2006-09-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760081806 | 1 Recovery | Community/Behavioral Health | 111 Daniels Dr, Fort Myers, FL 33908 | 2020-10-20 |
| 1457916462 | Avipharm, LLC | Pharmacy | 7669 Calistoble Loop, 2nd Floor, Fort Myers, FL 33908 | 2019-05-06 |
| 1013492289 | Craig M Stein | Pharmacist | 15236 Tropic Bird Court, Fort Myers, FL 33908 | 2018-10-03 |
| 1730665167 | Kyndra Lynn Petrick | Psychiatry & Neurology | 8560 Big Mangrove Dr, Fort Myers, FL 33908 | 2018-07-18 |
| 1447757547 | Douglas L Jarrett | Nurse Practitioner | 16261 Bass Rd Suite 300, Fort Myers, FL 33908 | 2018-04-06 |
| 1447754825 | Luis Daniel Ramos | General Practice | 15590 Ocean Walk Cir Apt 201, Fort Myers, FL 33908 | 2018-03-21 |
| 1619497062 | Vanesa Paola Vaquer | Dentist | 18070 S Tamiami Trl Ste 101, Fort Myers, FL 33908 | 2017-06-26 |
| 1962859603 | Teresa Ruiz | Behavior Technician | 15081 Woodrich Bend Ct Apt 416, Fort Myers, FL 33908 | 2016-05-23 |
| 1669865721 | Elena B. Alexiev | Dentist | 18070 S. Tamiami Trail, #101, Fort Myers, FL 33908 | 2015-03-13 |
| 1134488919 | Cecelia Anne Collins | Dietitian, Registered | 9215 Calle Arragon Avenue, Unit 205, Fort Myers, FL 33908 | 2012-05-14 |
| Find all providers in zip 33908 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679360 | Samantha Lee Zavada | Physician Assistant | 9459 Silver Pine Loop, Fort Myers, FL 33967-5152 | 2020-11-07 |
| 1811597198 | Alexis Thraen | Physician Assistant | 4536 Winkler Ave Apt 204, Fort Myers, FL 33966-7013 | 2020-10-27 |
| 1265065247 | Marathon Health LLC | Physician Assistant | 1660 Electric Ln, Fort Myers, FL 33917-3946 | 2020-02-18 |
| 1710510813 | Noshaba Khaliq | Physician Assistant | 17549 Cherry Ridge Ln, Fort Myers, FL 33967-5138 | 2020-02-17 |
| 1699307389 | Colleen Mcgonagle | Physician Assistant | 12700 Creekside Ln Ste 101, Fort Myers, FL 33919-3356 | 2020-02-10 |
| 1922643238 | Abigail Christine Reed | Physician Assistant | 16230 Summerlin Rd Ste 213-218, Fort Myers, FL 33908-5768 | 2019-11-11 |
| 1245899756 | Aileen Fiallo | Physician Assistant | 4571 Colonial Blvd Ste 210, Fort Myers, FL 33966-1156 | 2019-06-08 |
| 1316422199 | Angelia Lynette Sakyi-agyekum | Physician Assistant | 8291 Dani Dr Ste 101a, Fort Myers, FL 33966-8009 | 2018-09-27 |
| 1225547029 | Irene Julian | Physician Assistant | 14090 Metropolis Ave Ste 102, Fort Myers, FL 33912-4451 | 2017-09-25 |
| 1134653827 | Matthew Jeremy Blakemore | Physician Assistant | 6150 Diamond Centre Ct Ste 1300, Fort Myers, FL 33912-4367 | 2017-04-19 |
| Find all providers in FORT MYERS | ||||
| City | FORT MYERS |
| Zip Code | 33908 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.