Provider Demographics
NPI:1588154231
Name:CARMACK, LINDSAY TAYLOR ZOTOVICH (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:TAYLOR ZOTOVICH
Last Name:CARMACK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4621 PERHAM RD
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-3124
Mailing Address - Country:US
Mailing Address - Phone:949-300-6507
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 503
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7706
Practice Address - Country:US
Practice Address - Phone:949-718-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2023-08-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant