Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9391902 | FL |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 5006157 | NC |
NPI | 1033552534 |
---|---|
Provider Name | Miss Kelsie Michelle Mackenzie |
First Address | Gainesville, FL 32608-4723 |
Second Address | Gainesville, FL 32608-4723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 20/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013948500 | (05) | FL |