Provider Demographics
NPI:1922791847
Name:MCKENZIE, NATALLIA NASTASSIA (NP)
Entity type:Individual
Prefix:MRS
First Name:NATALLIA
Middle Name:NASTASSIA
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6134
Mailing Address - Country:US
Mailing Address - Phone:954-840-3225
Mailing Address - Fax:
Practice Address - Street 1:9900 W SAMPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4043
Practice Address - Country:US
Practice Address - Phone:954-840-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily