Provider Demographics
NPI:1942193503
Name:MA, NATHANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 NW 69TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3831
Mailing Address - Country:US
Mailing Address - Phone:954-461-5946
Mailing Address - Fax:
Practice Address - Street 1:10930 NW 69TH PL
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3831
Practice Address - Country:US
Practice Address - Phone:954-461-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant