MEDICARE: CHANTE MCKIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9120535	FL
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1669265617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTE MCKIE

Provider Business Mailing Address
First Line	:	2281 NW 33RD AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14320 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2601
Country	:	US
Telephone Number	:	813-280-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	12/01/2025

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Directions to “ CHANTE MCKIE ” Practice Location

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