Grace J Fantl (NPI# 1710461595, PAC ID# 0840536892) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1710461595 |
| PAC ID by PECOS | 0840536892 |
| Professional Enrollment ID | I20190111000732 |
| Full Name | Grace J Fantl |
| Organization Legal Name | MACINNIS DERMATOLOGY |
| Address |
17521 Us Hwy 441 Suite 21 Mount Dora FL 32757-6737 |
| Phone Number | 3523505230 |
| Gender | F |
| Graduation Year | 2018 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 1759424104 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 27950 Us Hwy 27, Leesburg, FL 34748-9050 | 3523505230 | MACINNIS DERMATOLOGY |
| 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 | 3523505230 | MACINNIS DERMATOLOGY |
| Organization Legal Name | MACINNIS DERMATOLOGY |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Beverly D Connolly | Physician Assistant | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Kay A Johnston | Dermatology | Macinnis Dermatology | 1950 Laurel Manor Dr, Suite 124, The Villages, FL 32162-5602 |
| Sarah Yoho | Physician Assistant | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Tonya M Terwilliger | Physician Assistant | Macinnis Dermatology | 1950 Laurel Manor Dr, Suite 124, The Villages, FL 32162-5602 |
| Colleen Macinnis | Dermatology | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Street Address |
17521 US HWY 441 SUITE 21 |
| City | MOUNT DORA |
| State | FL |
| Zip | 32757-6737 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Beverly D Connolly | Physician Assistant | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Sarah Yoho | Physician Assistant | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Colleen Macinnis | Dermatology | Macinnis Dermatology | 17521 Us Hwy 441, Suite 21, Mount Dora, FL 32757-6737 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nathan J Hanflink | Interventional Pain Management | 4601 N Hwy 19a, Mount Dora, FL 32757-2039 | |
| Vrej Kristapor Manoogian | Orthopedic Surgery | Manoogian Orthopedic Center Pa | 1945 Bay Rd, Mount Dora, FL 32757-2105 |
| Azalee L Brown | Nurse Practitioner | Manoogian Orthopedic Center Pa | 1945 Bay Rd, Mount Dora, FL 32757-2105 |
| Linda Steward | Physician Assistant | Manoogian Orthopedic Center Pa | 1945 Bay Rd, Mount Dora, FL 32757-2105 |
| Denise A Monert | Physical Therapy | 3800 Lake Ctr Dr, Suite B3, Mount Dora, FL 32757-2208 | |
| Kevin Thomas Taylor | Internal Medicine | 3801 N Hwy 19a, Suite 402, Mount Dora, FL 32757-2228 | |
| Ruth Meneses- Taylor | Nephrology | Center for Diseases of The Kidney and Hypertension Inc | 3801 N Hwy 19a, Suite 400, Mt Dora, FL 32757-2299 |
| Evan M Burke | Physical Therapy | 3425 Lake Ctr Dr, Suite 1, Mount Dora, FL 32757-2345 | |
| Shirley A Nagel | Internal Medicine | Adult Medicine of Lake County Inc | 3619 Lake Ctr Dr, Mount Dora, FL 32757-2364 |
| Joanne M Keller | Nurse Practitioner | Joanne M Keller Arnp Womens Health and Wellness Practice Pa | 3643 Lake Ctr Dr, Mount Dora, FL 32757-2364 |
| Find all physicians in zip 32757 | |||
| City | MOUNT DORA |
| Zip Code | 32757 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | MOUNT DORA + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Grace J Fantl.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.